Journal article
Diagnosing heart failure in primary care: individual patient data meta-analysis of two European prospective studies
- Abstract:
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Aims: Natriuretic peptides are helpful in detecting chronic heart failure (HF) in primary care, however there are a lack of data evaluating thresholds recommended by clinical guidelines. This study assesses the diagnostic accuracy of N-terminal pro-B-type natriuretic peptide (NT-proBNP) using combined individual patient data from two studies in the UK and The Netherlands.
Methods and results: Random effects methods were used to estimate the performance characteristics of NT-proBNP thresholds recommended by the European Society of Cardiology (ESC) and the UK National Institute for Health and Care Excellence (NICE) guidelines. New onset HF was diagnosed in 313 of 1073 (29.2%) participants. Age, sex and atrial fibrillation-adjusted NT-proBNP was a better predictor of HF with reduced ejection fraction (HFrEF) than preserved ejection fraction (HFpEF), with area under receiver operating characteristic curve of 0.82 95% CI (0.78 to 0.86) vs. 0.71 (0.66 to 0.75). In persons aged 70 years and over, the ESC threshold at 125ng/L for detection of all-cause HF had summary negative predictive value (NPV) of 84.9% (81.6 to 88.2), positive predictive value (PPV) 68.1% (63.1 to 73.3), sensitivity 74.9% (69.5 to 80.3) and specificity 80.1% (76.9 to 83.4); the NICE threshold at 400ng/L had summary NPV of 74.7% (72.1 to 77.2), PPV 81.8% (73.3 to 89.5), sensitivity 43.5% (37.2 to 49.8) and specificity 94.5% (92.3 to 96.7).
Conclusion: NT-proBNP is better at detecting HFrEF than HFpEF in a primary care setting. In persons aged 70 and over, the ESC threshold of 125ng/L is more accurate at detecting and excluding HF than the higher level suggested in NICE guidelines. More prospective data are required to establish the optimal NP threshold for detecting chronic HF in general practice.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 774.8KB, Terms of use)
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- Publisher copy:
- 10.1002/ehf2.13311
Authors
- Publisher:
- Wiley
- Journal:
- ESC Heart Failure More from this journal
- Volume:
- 8
- Issue:
- 3
- Pages:
- 2193-2201
- Publication date:
- 2021-03-23
- Acceptance date:
- 2021-03-09
- DOI:
- EISSN:
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2055-5822
- Language:
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English
- Keywords:
- Pubs id:
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1166896
- Local pid:
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pubs:1166896
- Deposit date:
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2021-03-11
- ARK identifier:
Terms of use
- Copyright holder:
- Roalfe et al.
- Copyright date:
- 2021
- Rights statement:
- © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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