Heart failure (HF) remains underdiagnosed in primary care, often due to the nonspecific nature of symptoms and limited access to diagnostic tools. The acronym “EPOF” (dyspnea, weight gain, oedema, fatigue) is used in France to raise awareness of HF-related symptoms, but its diagnostic value has not been formally assessed. We aimed to evaluate the association between EPOF symptoms and elevated NT-proBNP levels in a population without known HF participating in a national screening campaign.

In this study, we sought to determine whether EPOF symptoms are associated with elevated NT-proBNP levels in a population of adults with no known history of HF, who voluntarily participated in a national HF awareness and screening campaign. The primary objective was to assess the diagnostic value of individual and combined symptoms in identifying NT-proBNP > 125 pg/mL, the commonly used threshold for suspecting HF in ambulatory settings.

We conducted a prospective, multicenter screening study across 21 French hospitals and clinics. Adults at steady state with no prior history of HF underwent NT-proBNP testing via fingerstick and completed a symptom questionnaire. The primary outcome was the diagnostic performance of all four clinical “EPOF” signs to detect patients with elevated NT-proBNP defined as > 125 pg/mL.

Of 2481 participants, 419 (16.9%) had NT-proBNP > 125 pg/mL. Age, previous cardiology consultation, and history of coronary artery disease were independently associated with elevated NT-proBNP. Among the four symptoms, dyspnea was the most sensitive (47.7%) while weight gain was the most specific (84.7%) to detect NTproBNP > 125 pg/mL. The presence of ≥ 1 symptom yielded a sensitivity of 63.2% and negative predictive value of 85.0%, but specificity remained low (42.4%) for the primary outcome. When all four symptoms were present, specificity increased to 96.1% but sensitivity dropped to 7.1% ( Fig. 1 ).

In a nationwide screening population without known HF, NT-proBNP > 125 pg/mL was present in 16.9%. EPOF symptoms were more frequent in individuals with elevated NT-proBNP, but their individual diagnostic performance was limited. Combining symptom-based screening with NT-proBNP testing may help guide earlier identification and referral of patients at risk of HF in primary care.