Introduction NICE guidelines recommend that patients with suspected heart failure (HF) and raised natriuretic peptides are referred for timely echocardiography and specialist assessment. Limited data are available on whether this affects outcome. We provide Trust-based NTproBNP assays for primary care, a simple referral pathway and a dedicated one-stop HF clinic fully compliant with NICE waiting time targets. Despite this, it was apparent that many patients with suspected HF and raised NTproBNP levels were not being referred and were being managed in non-specialist primary care settings. The aim of this study was to compare hospitalisation and mortality rates in patients with suspected HF and raised NTproBNP who were reviewed in a HF clinic to those who were not referred.
Methods Data were collected retrospectively from hospital records. All patients with a raised NTproBNP (>400 pg/ml) from February to September 2014 were identified via the Trust biochemistry laboratory and were included in the study. These patients were divided into those referred to and reviewed in the clinic (HF Clinic) and those who were not referred (No HF Clinic). Hospital coding data, information services and case notes were used to identify hospital admissions, length of stay, reason for admission and mortality in all patients over a minimum follow up period of 6-months from the time of the raised NTproBNP result. Comparisons were then made between the HF clinic and No HF clinic cohorts.
Results 567 consecutive patients were identified: 161 (28%) in the HF Clinic group and 406 (72%) in the No HF Clinic group. All HF clinic patients were seen within 2 weeks (NTproBNP > 2000 pg/ml) or 6 weeks (NTproBNP 400–2000 pg/ml) in line with NICE recommendations. Mean follow up period was 8.9 ± 2.3 months. Mean patient age was 80 ± 9 years. The HF clinic cohort was slightly younger (Table 1). 52% of HF clinic patients were male versus 48% of No HF clinic patients (p = 0.42). Despite having a significantly higher NTproBNP level HF clinic patients had a much lower rate of all cause and cardiovascular admissions than the No HF clinic patients (Table 1 and Figure 1). There was no difference in mortality.
Conclusions Hospitalisation rates in patients with suspected heart failure and raised NTproBNP were extremely high over a relatively short follow up period. Patients reviewed in a specialist HF clinic had much higher NTproBNP levels, suggesting they were at higher risk of adverse outcomes, yet also had significantly lower rates of all cause and cardiovascular hospitalisation. The data are observational so causation and association cannot be separated however the magnitude of the difference between the patient groups suggests referral to HF clinics may improve outcomes. Our findings support implementation of the relevant NICE guidelines for patients with suspected HF and higher rates of referral from primary care should be encouraged.
- Heart failure
- NICE guidelines
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