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47 Using Natriuretic Peptide Levels to Diagnose Heart Failure in Primary Care: An Evaluation of the 2010 United Kingdom National Institute of Clinical Excellence Guidelines on the Diagnosis of Chronic Heart Failure
  1. Haqeel Jamil1,
  2. John Gierula2,
  3. Rowenna Byrom2,
  4. Sarah WInsor2,
  5. Emma Sunley2,
  6. Lorraine Kearney2,
  7. Anne Houghton2,
  8. Kristian Bailey2,
  9. Richard Cubbon2,
  10. Gregory Reynolds2,
  11. Sue Pavitt2,
  12. Cairns David2,
  13. Barth Julian2,
  14. Mark Davis2,
  15. Linda Sharples2,
  16. Mark Kearney2,
  17. Klaus Witte2
  1. 1University of Leeds
  2. 2Leeds NHS Trust

Abstract

Introduction Chronic heart failure (HF) due to left ventricular systolic dysfunction (LVSD) is common and associated with high morbidity and mortality. The 2010 UK National Institute for Health and Care Excellence (NICE) guideline (CG-108) advises the measurement of natriuretic peptides (NP) in patients presenting to primary care with symptoms possibly due to HF without previous myocardial infarction (MI); with elevated concentrations triggering referral to a HF clinic. The aim of this study was to describe the results of implementation of the 2010 NP-based diagnostic guidelines for HF.

Methods We prospectively collected demographic data from all patients in Leeds who underwent an NP test between 1st May 2012 and 1st May 2013. In those referred to the Leeds Integrated HF Service we collected clinical variables, electrocardiography and echocardiography data.

Results Of the 4415 NT-pro-B-type NP tests performed in the twelve months to May 1st 2013, 543 (12%) returned a ‘high’ result (>2000 ng/L), and 1067 (24%) an ‘intermediate’ result (400–2000 ng/L). Of 1610 patients with an elevated result and no previous MI, 820 (51%) were referred to secondary care. Patients with a previous MI or a ‘high’ result were more likely to have LVSD (83/173, 48% and 131/245, 53% respectively), than those with ‘intermediate’ concentrations (112/447, 25%). Overall, the yield from 4263 NP tests (in patients without a previous MI) was 243 new diagnoses of LVSD.

Conclusion Comprehensive implementation of the 2010 NICE guidelines for the diagnosis and management of HF has led to a large number of NT-pro-BNP tests and few new diagnoses.

  • left ventricular dysfunction
  • B-type natriuretic peptide
  • heart failure

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