NTproBNP Testing in Heart Failure and Diabetes by Sex and Age: A Large Real-World Irish Cohort Study

NT-proBNP is the recommended first-line investigation for suspected heart failure (HF) in primary care, yet utilisation remains below guideline standards internationally. Evidence from the United Kingdom shows low uptake and associated excess mortality when diagnostic pathways are not initiated. Whether similar gaps and inequities exist in Ireland, particularly among high-risk populations such as those with diabetes, has not been examined at scale. A retrospective cross-sectional analysis of a national Irish dataset was conducted, comprising 59,269 patients with confirmed HF and 187,802 patients with diabetes without HF. NT-proBNP testing rates were assessed by sex and age group across both cohorts and compared with an English national cohort. NT-proBNP testing was recorded in 42.1% of patients with HF and 25.3% of those with diabetes without HF, leaving most high-risk individuals without a recorded biomarker test. While higher than in comparable international cohorts, uptake remains below guideline expectations. Sex-based differences were minimal in the HF cohort (42.5% male vs 41.6% female), with only a small gap in the diabetes cohort (26.2% vs 24.1%). Age-related gradients were consistent: testing increased from 33.2% in HF patients aged 18–44 years to 42.8% in those aged ≥70 years, with a similar but lower pattern in the diabetes cohort (21.6% to 25.3%). NT-proBNP testing in Ireland is broadly equitable by sex but remains underutilised, particularly among younger and high-risk populations without diagnosed HF. Overall rates exceed English comparators but remain below guideline recommendations. While this may partly reflect differences in recording practices, the findings are consistent with genuine undertesting and warrant further investigation. Embedding systematic NT-proBNP screening within structured primary care programmes offers a scalable, low-cost and readily implementable strategy to improve early detection while optimising use of diagnostic resources. Key messages • Over 140,000 high-risk patients lacked NT-proBNP testing, indicating substantial missed diagnostic opportunity. • Biomarker-led pathways in primary care can improve early HF detection and target resource use more efficiently.