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Irish Journal of Medical Science

, Volume 177, Issue 3, pp 197–203 | Cite as

Diagnosis of new onset heart failure in the community: the importance of a shared-care approach and judicious use of BNP

  • G. Mak
  • M. Ryder
  • N. F. Murphy
  • C. O’Loughlin
  • D. McCaffrey
  • M. Ledwidge
  • K. McDonald
Original Article

Abstract

Background

Brain natriuretic peptide (BNP) may help general practitioners (GPs) to “rule-out” heart failure (HF) and reduce referral burden on specialist assessment clinics.

Aims

To determine the diagnostic value of BNP in HF referrals by GPs to a specialist unit.

Methods

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.

Results

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.

Conclusions

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.

Keywords

B-type natriuretic peptide Diagnosis General practise Heart failure 

Notes

Conflict of interest statement

None declared.

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Copyright information

© Royal Academy of Medicine in Ireland 2008

Authors and Affiliations

  • G. Mak
    • 1
  • M. Ryder
    • 1
  • N. F. Murphy
    • 1
  • C. O’Loughlin
    • 1
  • D. McCaffrey
    • 1
  • M. Ledwidge
    • 1
  • K. McDonald
    • 1
  1. 1.Heart Failure UnitSt. Vincent’s University HospitalDublin 4UK

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