Zegard, Abbasin, Naneishvili, Tamara, Viyapurapu, Ravi, Desai, Purushottam, White, Sam, Patel, Peysh A, Stegemann, Berthold, Zaphiriou, Alex, Qiu, Tian and Leyva, Francisco (2023). Diagnostic yield of a heart failure referral pathway using N-terminal pro-brain natriuretic peptide. Open Heart, 10 (2),
Abstract
Objective To determine the diagnostic yield of a 'high' N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with suspected heart failure (HF) referred from primary to secondary care. Methods In this retrospective study, cardiac diagnoses were quantified in consecutive patients with an NT-proBNP>400 ng/L referred from primary care centres to a specialist HF service. Results Among 654 consecutive patients (age: 78.5±9.72 years; 45.9% men; left ventricular ejection fraction (LVEF): 55.4±12.5% (mean±SD)), the primary diagnoses were: valvular disease (39.4%), HF (29.2%; 13.3% with LVEF<40%) and atrial fibrillation (AF; 17.3%). In terms of primary or secondary diagnoses, 68% of patients had valve disease, 46.9% had AF and 29.2% had HF. A cardiac diagnosis was made in 85.9%. In multivariable analyses, NT-proBNP predicted HF with LVEF<40% (OR: 10.2, 95% CI: 5.63 to 18.3) and HF with any LVEF (OR: 6.13, 95% CI: 3.79 to 9.93). In canonical linear discriminant analyses, NT-proBNP correctly identified 54.5% of patients with HF. The remainder were misclassified as valvular disease, AF or no cardiac diagnosis. Conclusion Among patients with an NT-proBNP>400 ng/L referred through a primary care HF pathway, most patients had valve disease or AF rather than HF. NT-proBNP cannot discriminate among HF, valve disease and AF. On this basis, NT-proBNP may be best employed in detecting cardiac disease in general rather than HF per se.
Publication DOI: | https://doi.org/10.1136/openhrt-2023-002469 |
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Divisions: | College of Health & Life Sciences > Aston Medical School > Translational Medicine Research Group (TMRG) College of Health & Life Sciences > Aston Medical School |
Additional Information: | © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
Uncontrolled Keywords: | atrial fibrillation,echocardiography,heart failure |
Publication ISSN: | 2053-3624 |
Last Modified: | 06 Aug 2024 09:55 |
Date Deposited: | 09 Oct 2023 07:35 |
Full Text Link: | |
Related URLs: |
https://openhea ... nt/10/2/e002469
(Publisher URL) http://www.scop ... tnerID=8YFLogxK (Scopus URL) |
PURE Output Type: | Article |
Published Date: | 2023-10-03 |
Accepted Date: | 2023-09-05 |
Submitted Date: | 2023-08-25 |
Authors: |
Zegard, Abbasin
Naneishvili, Tamara Viyapurapu, Ravi Desai, Purushottam White, Sam Patel, Peysh A Stegemann, Berthold Zaphiriou, Alex Qiu, Tian Leyva, Francisco |