NT-proBNP to exclude heart failure in primary care - a pragmatic, cluster-randomized study

Area of Science:

• Cardiology
• Primary Care Medicine
• Diagnostic Testing

Background:

• Heart failure (HF) diagnosis in primary care presents challenges.
• N-terminal pro B-type natriuretic peptide (NT-proBNP) is a valuable rule-out test for HF due to its high negative predictive value.
• Implementing NT-proBNP testing in real-world primary care settings requires evaluation of its impact on diagnostic effectiveness.

Purpose of the Study:

• To assess if offering NT-proBNP testing to general practitioners (GPs) increases the rate of heart failure diagnoses among patients referred to an outpatient HF clinic.
• To evaluate the diagnostic effectiveness of NT-proBNP in a pragmatic, cluster-randomized controlled trial in a real-life primary care setting.

Main Methods:

• A pragmatic, cluster-randomized controlled trial was conducted involving 69 GP practices.
• Practices were randomized into an intervention group (offered NT-proBNP testing) and a control group.
• The primary outcome was the number of patients diagnosed with HF after referral for echocardiography.

Main Results:

• The overall rate of HF diagnoses per 1000 patients was similar between the intervention and control groups (0.09 vs. 0.14, p=0.354).
• NT-proBNP testing was utilized in 36.6% of referred patients in the intervention group.
• Significantly more women were diagnosed with HF in the intervention group (56.3% vs. 0%, p=0.019), and referral rates increased significantly in the intervention group (p < .010).

Conclusions:

• Offering NT-proBNP testing to GPs in a real-life setting did not enhance the overall diagnostic effectiveness for heart failure.
• While NT-proBNP testing led to increased referrals and a higher diagnosis rate in women, it did not improve the overall diagnostic yield.
• Further strategies may be needed to optimize the use of NT-proBNP testing for improving HF diagnosis in primary care.