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Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart
Ralf E Harskamp1,2,3, Lukas De Clercq1,2, Lieke Veelers1
1Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Insights
N-terminal proBNP (NT-proBNP) is more effective than B-type natriuretic peptide (BNP) for diagnosing heart failure in primary care. Personalized thresholds offer a modest improvement in diagnostic accuracy over universal ones.
Area of Science:
- Cardiology
- Primary Care Medicine
- Biomarker Research
Background:
- Heart failure (HF) presents a significant health burden, necessitating timely diagnosis for improved patient outcomes.
- Accurate detection of HF in primary care settings is crucial for effective management and resource allocation.
Purpose of the Study:
- To compare the diagnostic performance of N-terminal proBNP (NT-proBNP) and B-type natriuretic peptide (BNP) in identifying HF in primary care.
- To assess whether personalized diagnostic thresholds improve accuracy over universal thresholds for natriuretic peptides in HF detection.
Main Methods:
- A retrospective analysis of 15,234 patients undergoing natriuretic peptide (NP) testing in primary care from 2011-2021.
- Diagnostic accuracy evaluated using AUROC, sensitivity, and specificity with guideline-recommended thresholds.
- Adjustments for confounding factors were made using inverse probability of treatment weighting.
Main Results:
- NT-proBNP demonstrated superior diagnostic accuracy (AUROC 89.9%) compared to BNP (AUROC 85.9%) for HF detection.
- NT-proBNP exhibited higher sensitivity (95.3%) and specificity (59.1%) than BNP (89.7% sensitivity, 58.0% specificity).
- Personalized NP thresholds provided a modest enhancement in diagnostic accuracy for both biomarkers.
Conclusions:
- NT-proBNP is a more accurate biomarker than BNP for diagnosing heart failure in primary care.
- The implementation of personalized diagnostic thresholds offers a marginal improvement in accuracy over universal thresholds for HF detection.
Objectives:
Heart failure (HF) is a prevalent syndrome with considerable disease burden, healthcare utilization and costs. Timely diagnosis is essential to improve outcomes. This study aimed to compare the diagnostic performance of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in detecting HF in primary care. Our second aim was to explore if personalized thresholds (using age, sex, or other readily available parameters) would further improve diagnostic accuracy over universal thresholds.
Methods:
A retrospective study was performed among patients without prior HF who underwent natriuretic peptide (NP) testing in the Amsterdam General Practice Network between January 2011 and December 2021. HF incidence was based on registration out to 90 days after NP testing. Diagnostic accuracy was evaluated with AUROC, sensitivity and specificity based on guideline-recommended thresholds (125 ng/L for NT-proBNP and 35 ng/L for BNP). We used inverse probability of treatment weighting to adjust for confounding.
Results:
A total of 15,234 patients underwent NP testing, 6,870 with BNP (4.5 % had HF), and 8,364 with NT-proBNP (5.7 % had HF). NT-proBNP was more accurate than BNP, with an AUROC of 89.9 % (95 % CI: 88.4-91.2) vs. 85.9 % (95 % CI 83.5-88.2), with higher sensitivity (95.3 vs. 89.7 %) and specificity (59.1 vs. 58.0 %). Differentiating NP cut-off by clinical variables modestly improved diagnostic accuracy for BNP and NT-proBNP compared with a universal threshold.
Conclusions:
NT-proBNP outperforms BNP for detecting HF in primary care. Personalized instead of universal diagnostic thresholds led to modest improvement.
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