Diagnosis of new onset heart failure in the community: the importance of a shared-care approach and judicious use of BNP.
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.
Mak
G
G
Heart Failure Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, UK. drgeorgemak@yahoo.com
Ryder
M
M
Murphy
N F
NF
O'Loughlin
C
C
McCaffrey
D
D
Ledwidge
M
M
McDonald
K
K
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
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain