Key result
Primary care natriuretic peptide testing increased ~67-fold, yet most heart failure patients remain untested before diagnosis.
Why the study?
Heart failure is often diagnosed on emergency hospital admission despite guidelines recommending primary care natriuretic peptide testing for timely diagnosis, prompting an evaluation of contemporary testing and diagnosis trends.
Cohort (n=7,212,013)
Yes
Despite a significant increase in natriuretic peptide testing in UK primary care following guideline updates, the vast majority of patients diagnosed with heart failure still do not undergo testing prior to diagnosis, highlighting missed opportunities for earlier detection.
Answers are grounded in this paper and cite their sources.
Persistent gaps in pre-diagnostic NP testing caution against assuming guideline impact; hypothesis-generating for primary care implementation strategies.
AIMS: Heart failure (HF) is a malignant condition with poor outcomes and is often diagnosed on emergency hospital admission. Natriuretic peptide (NP) testing in primary care is recommended in international guidelines to facilitate timely diagnosis. We aimed to report contemporary trends in NP testing and subsequent HF diagnosis rates over time. METHODS AND RESULTS: Cohort study using linked primary and secondary care data of adult (≥45 years) patients in England 2004-18 (n = 7 212 013, 48% male) to report trends in NP testing (over time, by age, sex, ethnicity, and socioeconomic status) and HF diagnosis rates. NP test rates increased from 0.25 per 1000 person-years [95% confidence interval (CI) 0.23-0.26] in 2004 to 16.88 per 1000 person-years (95% CI 16.73-17.03) in 2018, with a significant upward trend in 2010 following publication of national HF guidance. Women and different ethnic groups had similar test rates, and there was more NP testing in older and more socially deprived groups as expected. The HF detection rate was constant over the study period (around 10%) and the proportion of patients without NP testing prior to diagnosis remained high [99.6% (n = 13 484) in 2004 vs. 76.7% (n = 12 978) in 2017]. CONCLUSION: NP testing in primary care has increased over time, with no evidence of significant inequalities, but most patients with HF still do not have an NP test recorded prior to diagnosis. More NP testing in primary care may be needed to prevent hospitalization and facilitate HF diagnosis at an earlier, more treatable stage.
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Roalfe et al. (2021) conducted a cohort in Heart failure (n=7,212,013). Natriuretic peptide testing vs. Historical rates (2004) was evaluated on Natriuretic peptide test rates per 1000 person-years.
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