title: Diagnosis of new onset heart failure in the community: the importance of a shared-care approach and judicious use of BNP.
abstract: BACKGROUND
  Brain natriuretic peptide (BNP) may help general practitioners (GPs) to "rule-out" heart failure (HF) and reduce referral burden on specialist assessment clinics.
  
  
  OBJECTIVE
  To determine the diagnostic value of BNP in HF referrals by GPs to a specialist unit.
  
  
  METHODS
  From 2003 to 2007, 327 GP referrals were made to a HF new patient diagnostic clinic (NDC) with a provisional diagnosis of HF. The NDC provides rapid assessment of potential HF patients and ensures appropriate therapy and follow-up for those with a confirmed diagnosis. HF diagnosis was confirmed by the Framingham criteria.
  
  
  RESULTS
  HF was present in 39% of cases referred (mean age 75 +/- 10 years, 49% male). The inclusion of BNP as a "rule-out" test with a cut-off value of 100 pg/mL would have reduced the number of patients originally referred to the NDC by 175. However, this would have resulted in delayed diagnosis and treatment of 20 (16%) "false-negative" patients.
  
  
  CONCLUSIONS
  Availability of BNP to GPs would improve referral patterns but with high risk of delayed diagnosis. The data underline the need for a shared-care approach to the new diagnosis of HF.
authors.affiliation: Heart Failure Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, UK. drgeorgemak@yahoo.com
authors.forename: G
authors.initials: G
authors.lastname: Mak
authors.forename: M
authors.initials: M
authors.lastname: Ryder
authors.forename: N F
authors.initials: NF
authors.lastname: Murphy
authors.forename: C
authors.initials: C
authors.lastname: O'Loughlin
authors.forename: D
authors.initials: D
authors.lastname: McCaffrey
authors.forename: M
authors.initials: M
authors.lastname: Ledwidge
authors.forename: K
authors.initials: K
authors.lastname: McDonald
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain