Key result
Natriuretic peptide testing was deemed the appropriate routine initial test for suspected heart failure, with echocardiography preferred or added when an abnormal electrocardiogram is present.
Why the study?
What are the appropriate clinical scenarios for UK GPs to refer patients with suspected heart failure for natriuretic peptide testing or echocardiography?
What are the appropriate clinical scenarios for UK GPs to refer patients with suspected heart failure for natriuretic peptide testing or echocardiography?
An expert panel of UK GPs determined that natriuretic peptide testing should be the routine initial diagnostic test for suspected heart failure, with echocardiography reserved for follow-up of abnormal NP tests or alongside NP testing when the ECG is abnormal.
Supports NP-first strategy for suspected HF in UK primary care; leaves open need for prospective outcome validation.
BACKGROUND: Some UK GPs are acquiring access to natriuretic peptide (NP) testing or echocardiography as diagnostic tests for heart failure. This study developed appropriateness ratings for the diagnostic application of these tests in routine general practice. AIM: To develop appropriateness ratings for the diagnostic application of NP testing or echocardiography for heart failure in general practice. DESIGN AND SETTING: An appropriateness ratings evaluation in UK general practice. METHOD: Four presenting symptoms (cough, bilateral ankle swelling, dyspnoea, fatigue), three levels of risk of cardiovascular disease (low, intermediate, high), and dichotomous categorisations of cardiovascular/chest examination and electrocardiogram result, were used to create 540 appropriateness scenarios for patients in whom NP testing or echocardiography might be considered. These were rated by a 10-person expert panel, consisting of GPs and GPs with specialist interests in cardiology, in a two-round RAND Appropriateness Method. RESULTS: Onward referral for NP testing or echocardiography was rated as an appropriate next step in 217 (40.2%) of the 540 scenarios; in 194 (35.9%) it was rated inappropriate. The ratings also show where NP testing or echocardiography were ranked as equivalent next steps and when one test was seen as the more appropriate than the other. CONCLUSION: NP testing should be the routine test for suspected heart failure where referral for diagnostic testing is considered appropriate. An abnormal electrocardiogram status makes referral to echocardiography an accompanying, or more appropriate, next step alongside NP testing, especially in the presence of dyspnoea. Abnormal NP testing should subsequently be followed up with referral for echocardiography.
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Campbell et al. (2011) studied Suspected heart failure (n=10). Natriuretic peptide (NP) testing and echocardiography vs. No further investigation was evaluated on Appropriateness of onward referral for NP testing or echocardiography. Natriuretic peptide testing was deemed the appropriate routine initial test for suspected heart failure, with echocardiography preferred or added when an abnormal electrocardiogram is present.
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