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Impact of using different guideline recommended serum natriuretic peptide thresholds on the diagnosis and referral rates of a diagnostic heart failure clinic

Lookup NU author(s): Dr Iftikhar Fazal, Dr R Neely, Dr Guy MacGowanORCiD, Dr Jane Skinner

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Abstract

Aims: The aims of this study were to determine the diagnostic yield of a dedicated heart failure diagnosis clinic and the impact of using different guideline recommended N-terminal pro B-type natriuretic peptide (NT-proBNP) referral thresholds on diagnosis and referral patterns. Methods and results: Patients referred by primary care between September 2011 and May 2013 were included in the analysis. Data collected included baseline characteristics, NT-proBNP levels, echocardiographic and clinical findings, final diagnosis and outcome. The impact of using Newcastle (locally modified age-adjusted NT-proBNP thresholds), National Institute for Health and Care Excellence (NICE) and European Society of Cardiology (ESC) NT-proBNP thresholds on diagnosis and referrals was determined by applying the different guidelines to this population. A total of 208 patients were referred; median age 77.5 years and 62.5% were women. Thirty-four patients (16.3%) had systolic heart failure, 50 patients (24.0%) had heart failure with preserved ejection fraction. One hundred and six patients (51.0%) did not have heart failure. Using NICE guidelines (NT-proBNP >= 400 ng/l) instead of the Newcastle age-adjusted NT-proBNP referral thresholds results in 59 fewer referrals, but eight heart failure diagnoses were missed. Using the ESC cut-off of NT-proBNP >= 125 ng/l would result in 88 additional referrals; one diagnosis of heart failure would be missed. Over a mean follow-up of 16.8 +/- 6 months there were 21 deaths and 47 hospital admissions. Conclusion: The Newcastle age-adjusted thresholds led to more referrals in comparison to NICE guidelines but are more sensitive in diagnosing heart failure. Using ESC recommended thresholds results in a similar diagnostic yield to our age-adjusted thresholds, but has the potential to significantly increase the referrals in patients >= 75 years, which may result in a lower diagnostic yield.

Publication metadata

Author(s): Fazal IA, Bhagra SK, Bailey KM, Neely RD, MacGowan GA, Skinner JS

Publication type: Article

Publication status: Published

Journal: International Journal of Clinical Practice

Year: 2015

Volume: 69

Issue: 11

Pages: 1349-1356

Print publication date: 01/11/2015

Online publication date: 21/07/2015

Acceptance date: 15/06/2015

ISSN (print): 1368-5031

ISSN (electronic): 1742-1241

Publisher: Wiley-Blackwell Publishing Ltd.

URL: http://dx.doi.org/10.1111/ijcp.12694

DOI: 10.1111/ijcp.12694

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