title: Do laboratories follow heart failure recommendations and guidelines and did we improve? The CARdiac MArker Guideline Uptake in Europe (CARMAGUE).
abstract: BACKGROUND
  Natriuretic peptides (NP) are well-established markers of heart failure (HF). During the past 5 years, analytical and clinical recommendations for measurement of these biomarkers have been published in guidelines. The aim of this follow-up survey was to investigate how well these guidelines for measurement of NP have been implemented in laboratory practice in Europe.
  
  
  METHODS
  Member societies of the European Federation of Clinical Chemistry and Laboratory Medicine were invited in 2009 to participate in a web-based audit questionnaire. The questionnaire requested information on type of tests performed, decision limits for HF, turn-around time and frequency of testing.
  
  
  RESULTS
  There was a moderate increase (12%) of laboratories measuring NP compared to the initial survey in 2006. The most frequently used HF decision limits for B-type NP (BNP) and N-terminal BNP (NT-proBNP) were, respectively, 100 ng/L and 125 ng/L, derived from the package inserts in 55%. Fifty laboratories used a second decision limit. Age or gender dependent decision limits were applied in 10% (8.5% in 2006). The vast majority of laboratories (80%) did not have any criteria regarding frequency of testing, compared to 33% in 2006.
  
  
  CONCLUSIONS
  The implementation of NP measurement for HF management was a slow process between 2006 and 2009 at a time when guidelines had just been established. The decision limits were derived from package insert information and literature. There was great uncertainty concerning frequency of testing which may reflect the debate about the biological variability which was not published for most of the assays in 2009.
authors: Central Institute for Medical and Chemical Laboratory Diagnosis, University Hospital Innsbruck, Austria. Angelika.Hammerer-Lercher@uki.at
authors: Angelika
authors: A
authors: Hammerer-Lercher
authors: Paul
authors: P
authors: Collinson
authors: Marja P
authors: MP
authors: van Dieijen-Visser
authors: Kari
authors: K
authors: Pulkki
authors: Janne
authors: J
authors: Suvisaari
authors: Jan
authors: J
authors: Ravkilde
authors: Ana
authors: A
authors: Stavljenic-Rukavina
authors: Hannsjörg
authors: H
authors: Baum
authors: Päivi
authors: P
authors: Laitinen
mesh_terms: D005060:Europe; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007753:Laboratories / Q000592:standards*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D017410:Practice Guidelines as Topic
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain