Prospective evaluation and long-term follow-up of patients referred to secondary care based upon natriuretic peptide levels in primary care.
B-type natriuretic peptide
Heart failure
Left ventricular dysfunction
Journal
European heart journal. Quality of care & clinical outcomes
ISSN: 2058-1742
Titre abrégé: Eur Heart J Qual Care Clin Outcomes
Pays: England
ID NLM: 101677796
Informations de publication
Date de publication:
01 07 2019
01 07 2019
Historique:
received:
09
08
2018
revised:
07
11
2018
accepted:
19
11
2018
pubmed:
20
11
2018
medline:
1
8
2020
entrez:
20
11
2018
Statut:
ppublish
Résumé
The UK National Institute for Health and Care Excellence (UK-NICE) and European Society of Cardiology (ESC) guidelines advise natriuretic peptide (NP) assessment in patients presenting to primary care with symptoms possibly due to chronic heart failure (HF), to determine need for specialist involvement. This prospective service evaluation aimed to describe the diagnostic and prognostic utility of these guidelines. We prospectively collected clinical, echocardiography and outcomes data (minimum 5 years) from all patients referred to the Leeds HF Service for 12 months of following the initiation of the NP-guideline-directed pathway. Between 1 May 2012 and 1 August 2013, 1020 people with symptoms possibly due to HF attended either with a raised NT-pro-BNP or a previous myocardial infarction (MI) with an overall rate of left ventricular systolic dysfunction (LVSD) of 33%. Of these, 991 satisfied the ESC criteria (NT-pro-BNP ≥125 pg/mL) in whom the rate of LVSD was 32%, and 821 the UK-NICE criteria in whom the rate of LVSD was 49% in those with a previous MI, 25% in those with NT-pro-BNP concentration 400-2000 pg/mL, and 54% in those with NT-pro-BNP concentration of >2000 pg/mL. An NT-pro-BNP concentration 125-400 pg/mL had a 12% risk of LVSD. Specificity was poor in women >70 years, who made up the largest proportion of attendees. Elevated NT-pro-BNP levels were associated with lower survival even in the absence of LVSD. In people referred through the ESC and UK-NICE guidelines, elevated NT-pro-BNP is a marker of increased mortality risk, but there is wide variation in specificity for LVSD. Age- and sex-adjusted criteria might improve performance.
Identifiants
pubmed: 30452611
pii: 5189700
doi: 10.1093/ehjqcco/qcy053
pmc: PMC6613597
doi:
Substances chimiques
Peptide Fragments
0
pro-brain natriuretic peptide (1-76)
0
Natriuretic Peptide, Brain
114471-18-0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
218-224Subventions
Organisme : British Heart Foundation
ID : FS/12/80/29821
Pays : United Kingdom
Organisme : Department of Health
ID : HCS DRF-2014-05-006
Pays : United Kingdom
Organisme : Department of Health
ID : ICA-CDRF-2016-02-055
Pays : United Kingdom
Organisme : Department of Health
ID : NIHR-CS-012-032
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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