Abstract
AimsNatriuretic peptides are helpful in detecting chronic heart failure (HF) in primary care; however, there are a lack of data evaluating thresholds recommended by clinical guidelines. This study assesses the diagnostic accuracy of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) using combined individual patient data from two studies in the UK and the Netherlands.Methods and resultsRandom effects methods were used to estimate the performance characteristics of NT‐proBNP thresholds recommended by the European Society of Cardiology (ESC) and the UK National Institute for Health and Care Excellence (NICE) guidelines. New onset HF was diagnosed in 313 of 1073 (29.2%) participants. Age, sex, and atrial fibrillation‐adjusted NT‐proBNP was a better predictor of HF with reduced ejection fraction (HFrEF) than HF preserved ejection fraction (HFpEF), with area under receiver operating characteristic curve of 0.82 95% CI (0.78 to 0.86) vs. 0.71 (0.66 to 0.75). In persons aged 70 years and over, the ESC threshold at 125 ng/L for detection of all‐cause HF had summary negative predictive value (NPV) of 84.9% (81.6 to 88.2), positive predictive value (PPV) 68.1% (63.1 to 73.3), sensitivity 74.9% (69.5 to 80.3), and specificity 80.1% (76.9 to 83.4); the NICE threshold at 400 ng/L had summary NPV of 74.7% (72.1 to 77.2), PPV 81.8% (73.3 to 89.5), sensitivity 43.5% (37.2 to 49.8), and specificity 94.5% (92.3 to 96.7).ConclusionsN‐terminal pro‐B‐type natriuretic peptide is better at detecting HFrEF than HFpEF in a primary care setting. In persons aged 70 and over, the ESC threshold of 125 ng/L is more accurate at detecting and excluding HF than the higher level suggested in NICE guidelines. More prospective data are required to establish the optimal NP threshold for detecting chronic HF in general practice.
Highlights
Heart failure (HF) is an increasingly prevalent condition due to an ageing population[1] with only modest improvement observed in long-term survival in the UK over the last 20 years.[2,3] The importance of early diagnosis, when evidence-based treatments can be initiated, is critical
New onset HF was confirmed in 313 (29.2%) of the pooled dataset, with a similar prevalence of HF recorded in each study [106 (30.1%) in REFerral for EchocaRdiography (REFER) vs. 207 (28.7%) in Utrecht HartFalen Onderzoek (UHFO)]
Atrial fibrillation was observed in a similar percentage of HF cases in each dataset (20.8% in REFER vs. 27.1% in UHFO)
Summary
Heart failure (HF) is an increasingly prevalent condition due to an ageing population[1] with only modest improvement observed in long-term survival in the UK over the last 20 years.[2,3] The importance of early diagnosis, when evidence-based treatments can be initiated, is critical. There is evidence from routinely collected primary care data of delayed HF diagnosis despite most patients with HF consulting their. B-type NP and the inactive fragment NT-proBNP are available in primary care to assist HF diagnosis, but the threshold for ruling out HF differs between guidelines. The UK National Institute for Health and Care Excellence (NICE) guideline for chronic HF states that at a NT-proBNP level of
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