The exact role of natriuretic peptides in general practice remains to be defined.1 While raised plasma concentrations of N-terminal atrial natriuretic peptide (N-ANP) or brain natriuretic peptide (BNP) are associated with left ventricular systolic dysfunction and heart failure,2-4 the prognostic value of these peptides outside hospital populations remains uninvestigated. We recently showed that the risk of left ventricular systolic dysfunction in heart patients from general practice can be assessed from abnormal N-ANP concentrations, abnormal ECG, and a heart rate > diastolic blood pressure.3 The importance of these prespecified variables, in particular a raised N-ANP, would be confirmed if they also predicted mortality. The present follow up study from general practice examines this question.

All subjects ⩾ 40 years of age from one general practice and all subjects ⩾ 50 years of age from two general practices in Copenhagen were screened from 1994 to 1996 by a procedure based on a questionnaire and review of general practice records. Of 2158 subjects, 357 had past or present signs or symptoms of heart disease; of these, 105 were excluded (and not invited for examination),126 withdrew, and 126 subjects were examined. Reasons for exclusion by priority were: 38 living in nursing homes, 36 questionnaire non-responders, 21 patients without definite heart disease for administrative reasons in an early study phase, and 10 patients with advanced heart failure. Half the remaining subjects withdrew: 32 declined the invitation, 1 died, 37 were disabled because of various medical and psychosocial conditions, and 56 patients, after various …