Diagnosis of new onset heart failure in the community: the importance of a shared-care approach and judicious use of BNP
Brain natriuretic peptide (BNP) may help general practitioners (GPs) to “rule-out” heart failure (HF) and reduce referral burden on specialist assessment clinics.
To determine the diagnostic value of BNP in HF referrals by GPs to a specialist unit.
From 2003 to 2007, 327 GP referrals were made to a HF new patient diagnostic clinic (NDC) with a provisional diagnosis of HF. The NDC provides rapid assessment of potential HF patients and ensures appropriate therapy and follow-up for those with a confirmed diagnosis. HF diagnosis was confirmed by the Framingham criteria.
HF was present in 39% of cases referred (mean age 75 ± 10 years, 49% male). The inclusion of BNP as a “rule-out” test with a cut-off value of 100 pg/mL would have reduced the number of patients originally referred to the NDC by 175. However, this would have resulted in delayed diagnosis and treatment of 20 (16%) “false-negative” patients.
Availability of BNP to GPs would improve referral patterns but with high risk of delayed diagnosis. The data underline the need for a shared-care approach to the new diagnosis of HF.
KeywordsB-type natriuretic peptide Diagnosis General practise Heart failure
Conflict of interest statement
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