Abstract
Background: The value of routine aminoterminal pro type B natriuretic peptide (NT-proBNP) measurements in outpatient clinics remains unknown. Objectives: We sought to determine the accuracy with which heart failure (HF) specialists can predict NT-proBNP levels in HF outpatients based on clinical assessment.Methods: We prospectively studied 160 consecutive HF patients followed in an outpatient multidisciplinary HF clinic. During a regular office visit, HF specialists were asked to estimate a patient’s current NT-proBNP level based upon their clinical assessment and all available information from their chart, including a previous NT-proBNP level (if available). NT-proBNP estimations were grouped into prognostic categories (<125, 125-1000, 1000-4998, or ≥4999 pg/mL) and comparisons made between actual and estimate values. Results: Overall, HF specialists estimated 67.5% of NT-proBNP levels correctly. After adjusting for clinical characteristics, knowledge of a prior NT-proBNP measurement was the only significant predictor of estimation accuracy (p=0.01). Compared to patients with a prior NT-proBNP level <125 pg/mL, physicians were 95% less likely to get a correct estimation in patients with the highest prior NT-proBNP level (≥4999 pg/mL). Conclusion: HF specialists are reasonably accurate at estimating current NT-proBNP levels based upon clinical assessment and a previous NT-proBNP level, if those levels were < 4999 pg/mL. Likely, initial but not routine NT-proBNP measurements are useful in outpatient HF clinics.
Highlights
B-type natriuretic peptide (BNP) is released from ventricular myocardial tissue in response to increased wall stress. Both BNP and aminoterminal pro-type B natriuretic peptide (NT-proBNP), an inactive amino acid product of BNP prohormone cleavage, can be measured in the serum and both are typically elevated in heart failure (HF)
Actual and estimated NT-proBNP levels were recorded by an independent physician, in addition to gender, age, previous NT-proBNP level, current body mass index (BMI), most recent glomerular filtration rate, and current New York Heart Association (NYHA) class
We found that HF specialists are relatively accurate at estimating NT-proBNP prognostic categories based upon clinical assessment and a previous NT-proBNP level
Summary
B-type natriuretic peptide (BNP) is released from ventricular myocardial tissue in response to increased wall stress. Both BNP and aminoterminal pro-type B natriuretic peptide (NT-proBNP), an inactive amino acid product of BNP prohormone cleavage, can be measured in the serum and both are typically elevated in heart failure (HF). NT-proBNP is frequently measured at regular intervals in HF outpatients. Multiple studies have demonstrated the value of NT-proBNP in the diagnosis of congestive HF [1,2,3,4,5,6]. Studies have not been conducted looking at the cost-effectiveness of regular outpatient NT-proBNP measurements. The value of routine aminoterminal pro type B natriuretic peptide (NT-proBNP) measurements in outpatient clinics remains unknown
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