Key result
BNP assay poorly discriminated patients with and without systolic dysfunction (AUC 0.612) or any significant echocardiographic abnormality (AUC 0.723) in a primary care heart failure register.
Why the study?
Does BNP assay accurately identify echocardiographic abnormalities consistent with heart failure in primary care patients on a heart failure register?
Cross-Sectional (n=217)
No
Does BNP assay accurately identify echocardiographic abnormalities consistent with heart failure in primary care patients on a heart failure register?
Effect estimate: AUC 0.612
BNP testing is not a useful tool for the retrospective diagnostic validation of heart failure in primary care patients who are already receiving treatment.
BNP testing lacks utility for retrospective HF validation in primary care registers; leaves open its role in untreated or incident cases and requires prospective study.
BACKGROUND: Diagnosing heart failure and left ventricular systolic dysfunction is difficult on clinical grounds alone. We sought to determine the accuracy of a heart failure register in a single primary care practice, and to examine the usefulness of b-type (or brain) natriuretic peptide (BNP) assay for this purpose. METHODS: A register validation audit in a single general practice in the UK was carried out. Of 217 patients on the heart failure register, 56 of 61 patients who had not been previously investigated underwent 12-lead electrocardiography and echocardiography within the practice site. Plasma was obtained for BNP assay from 45 subjects, and its performance in identifying echocardiographic abnormalities consistent with heart failure was assessed by analysing area under receiver operator characteristic (ROC) curves. RESULTS: 30/217 were found to have no evidence to suggest heart failure on notes review and were probably incorrectly coded. 70/112 who were previously investigated were confirmed to have heart failure. Of those not previously investigated, 24/56 (42.9%) who attended for the study had echocardiographic left ventricular systolic dysfunction. A further 8 (14.3%) had normal systolic function, but had left ventricular hypertrophy or significant valve disease. Overall, echocardiographic features consistent with heart failure were found in only 102/203 (50.2%). BNP was poor at discriminating those with and without systolic dysfunction (area under ROC curve 0.612), and those with and without any significant echocardiographic abnormality (area under ROC curve 0.723). CONCLUSION: In this practice, half of the registered patients did not have significant cardiac dysfunction. On-site echocardiography identifies patients who can be removed from the heart failure register. The use of BNP assay to determine which patients require echocardiography is not supported by these data.
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Bhatia et al. (2007) conducted a cross-sectional in Heart failure (n=217). B-type Natriuretic Peptide (BNP) assay was evaluated on Discrimination of left ventricular systolic dysfunction (Area under ROC curve) (AUC 0.612). BNP assay poorly discriminated patients with and without systolic dysfunction (AUC 0.612) or any significant echocardiographic abnormality (AUC 0.723) in a primary care heart failure register.
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