title: The use of amino-terminal fraction brain natriuretic peptide (NT-proBNP) assays in general practices in Waikato, New Zealand.
abstract: OBJECTIVE
  To assess the use of the amino-terminal fraction brain natriuretic peptide (NT-proBNP) assay in the management of patients with suspected heart failure in general practice in Waikato District Health Board (DHB).
  
  
  METHODS
  We undertook an audit of all BNP requests to Waikato Health Laboratory from 1 March 2005 to 28 February 2006 inclusive. Data were analysed for age, gender, test result, and requesting general practitioner (GP). Crude incidence rate of BNP test by age group, sex, and by district was obtained. Second tests were analysed to ascertain numbers of patients re-tested in primary care.
  
  
  RESULTS
  1553 tests were ordered on 1327 patients; 1182 (89%) of patients had only one test in primary care; 680 (51.2%) of first tests were <40 pmol/L, 409 (30.8%) were between 40-220 pmol/L; and 238 (17.9%) were >220 pmol/L. Of the estimated 250 GPs in Waikato DHB, 75% (189) of GPs had requested one or more BNP tests. 27% (51/189) of GPs requested a repeat test on one or more patient. 27% of patients with result >220 pmol/L had a further BNP test in general practice.
  
  
  CONCLUSIONS
  The majority of Waikato GPs have experience with BNP testing in primary care. It appears to be used appropriately as a tool to rule out the diagnosis of heart failure by most GPs. A small number of doctors appear to use BNP more frequently, possibly to monitor treatment or change in condition (an indication for which it is not currently recommended). The use of BNP varies by district.
authors.affiliation: Waikato Clinical School, Peter Rothwell Academic Centre, Waikato Hospital, Hamilton, Waikato. gibbonsv@waikatodhb.govt.nz
authors.forename: Veronique
authors.initials: V
authors.lastname: Gibbons
authors.forename: Gerard
authors.initials: G
authors.lastname: Devlin
authors.forename: John
authors.initials: J
authors.lastname: Speed
authors.forename: Ross
authors.initials: R
authors.lastname: Lawrenson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009520:New Zealand; D010446:Peptide Fragments / Q000097:blood*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain