Point-of-care NT-proBNP monitoring for heart failure: observational feasibility study in primary care.

Jason Chami,Clare J Taylor,Rafael Perera,Susannah Fleming,Brian Shine,Julie Mclellan,Clare R Bankhead,Tim James,Fd Richard Hobbs

doi:10.3399/bjgpo.2022.0005

Abstract

Around one million individuals in the UK have heart failure (HF), a chronic disease that causes significant morbidity and mortality. N-terminal pro-B-type natriuretic peptide (NT-proBNP) monitoring could help improve the care of patients with HF in the community. The aim of this study is to provide evidence to support the routine use of point-of-care (POC) NT-proBNP monitoring in primary care. In this observational cohort study, the Roche Cobas h 232 POC device was used to measure NT-proBNP in 27 patients with HF at 0, 6, and 12 months, with a subset reanalysed in the laboratory for comparison. Data were analysed for within-person and between-person variability and concordance with laboratory readings using Passing-Bablok regression. GPs reported whether POC results impacted clinical decisionmaking, and patients indicated their willingness to participate in long-term cohort studies using the Likert acceptability scale. Within-person variability in POC NT-proBNP over 12 months was 881 pg/mL (95% confidence interval [CI] = 380 to 1382 pg/mL). Between-person variability was 1972 pg/mL (95% CI = 1,525 to 2791 pg/mL). Passing-Bablok regression showed no significant systematic difference between POC and laboratory measurements. Patients indicated a high level of acceptability, and GP decisionmaking was affected for at least one visit in a third of patients. Within-person variability in POC NT-proBNP is around half of between-person variability, so detecting changes could be of use in HF management. High patient acceptability and impact on clinical decisionmaking warrant further investigation in a larger long-term cohort study.

Highlights

Every year in the UK, more than 190,000 people are newly diagnosed with heart failure (HF) [1], a chronic disease that carries significant risk of morbidity and mortality
Within person variability in POC NT-proBNP is around half of between-person variability, so detecting changes could be of use in HF management
Heart failure, point-of-care testing, primary health care, family practice, general practice. How this fits in N-terminal pro–B-type natriuretic peptide (NT-proBNP) is used to diagnose and manage heart failure in the UK

Summary

Introduction

Every year in the UK, more than 190,000 people are newly diagnosed with heart failure (HF) [1], a chronic disease that carries significant risk of morbidity and mortality. Patients with established HF receive much of their care in the community, either in primary care, or through specialist community HF nurses. These patients may only be referred back to secondary or tertiary care if they experience acute illness. Around one million individuals in the UK have heart failure (HF), a chronic disease that causes significant morbidity and mortality. N-terminal pro–B-type natriuretic peptide (NTproBNP) monitoring could help improve the care of patients with HF in the community

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