title: [Natriuretic peptides for the management of patients with heart failure: a bridge between primary care and cardiology?].
abstract: BACKGROUND
  The increasing prevalence of heart failure (HF) mandates the establishment of shared strategies between primary care physicians (PCP) and cardiologists to offer patients continuity of care. Easily available, low-cost biomarkers hold potential to facilitate this process. Data on the diffusion of natriuretic peptides (NP), a major novelty in the HF field in the last decade, in primary care are scarce.
  
  
  METHODS
  The Cardiovascular Area of the Italian General Practice Society led a web survey among its members to investigate knowledge, perceptions and use of NP for HF management among Italian PCP.
  
  
  RESULTS
  Over 700 PCP took part in the survey, three out of four declared they never or only occasionally prescribed NP assays. Among participating PCP, 86% reported that PN values were not regularly mentioned in discharge summaries of their patients hospitalized for acute HF. Conversely, only 4% reported to receive regularly PN prescription by cardiologists for their outpatients with chronic HF. One of five respondents ignored whether the assay was reimbursed by the National Health Service. The high negative predictive value for HF of elevated NP levels, the strongest evidence-based indication of NP, was correctly pointed out only by 13% of PCP.
  
  
  CONCLUSIONS
  In our PCP sample, we documented a marginal use of NP in the management of HF patients. This is likely, at least in part, linked to a perceived scarce indication of NP values in discharge summaries and limited prescription in HF outpatients by cardiologists. Overall, PCP knowledge of the evidence on NP assay use for diagnosis, risk stratification and guided therapy of HF was limited. Two expert cardiologists were asked to comment on these findings and on the controversial aspects of the current use of NP in HF patients to better define their role as a tool for shared care between cardiologists and PCP.
authors.affiliation: Società Italiana di Medicina Generale, Firenze.
authors.forename: Gaetano
authors.initials: G
authors.lastname: D'Ambrosio
authors.affiliation: Società Italiana di Medicina Generale, Firenze.
authors.forename: Damiano
authors.initials: D
authors.lastname: Parretti
authors.affiliation: Istituto di Fisiologia Clinica del CNR, Dipartimento Cardiotoracovascolare "A. De Gasperis", A.O. Ospedale Niguarda Ca' Granda, Milano.
authors.forename: Renata
authors.initials: R
authors.lastname: De Maria
authors.affiliation: Società Italiana di Medicina Generale, Firenze.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Cricelli
authors.affiliation: U.O. Cardiologia, Azienda Istituti Ospitalieri, Cremona.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Tano
authors.affiliation: U.O. Cardiologia, Ospedale San Filippo Neri, Roma.
authors.forename: Nadia
authors.initials: N
authors.lastname: Aspromonte
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002309:Cardiology / Q000706:statistics & numerical data; D003266:Continuity of Patient Care; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000097:blood*; D058007:Physicians, Primary Care / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides