Heart failure

Three in four heart failure patients do not have a natriuretic peptide test prior to diagnosis

Despite an increase in the use of natriuretic peptide (PN) testing in general medicine, testing is still not done in three in four people before they are diagnosed with heart failure, a study has shown.

This suggests that there may be more opportunities to catch the disease at an earlier stage, researchers at the University of Oxford said.

Analysis of data from more than 1,000 general surgeries between 2004 and 2018 showed that the number of NP tests performed increased from 712 to 48,832 per year, with a particular increase after the update of the 2010 NICE guidelines on ‘heart failure.

But only one in four people with heart failure had a PN test in the six months before their diagnosis, meaning many could still be diagnosed at an earlier stage, the researchers concluded. European Journal of the Heart.

In 2004, 99.6% of patients had not had a PN test before they were diagnosed with heart failure, but by 2017, this had risen to 76.7%, according to the analysis.

The data has shown that there are no inequalities in testing related to gender or ethnicity, and more testing is done in older groups and in more disadvantaged populations where you would expect. higher rates of heart failure.

The researchers noted that previous research has shown that some patients can normalize their symptoms until they are severe enough to have a substantial impact on their daily activities.

But they said greater public awareness, a higher index of suspicion of heart failure in primary care, and an increase in NP testing in people with symptoms such as shortness of breath, fatigue and fatigue. swollen ankles are needed to stimulate early diagnosis.

Study director Dr Clare Taylor, a general practitioner and university lecturer at NIHR at the University of Oxford, said heart failure affects one million people in the UK.

“There are 200,000 new cases every year, and about 80% of these patients are not diagnosed until they are so sick that they have had to be hospitalized.

“As general practitioners, we can do a simple blood test in primary care that tells us if heart failure is likely. The heart failure detection rate in our 14-year study has remained the same, suggesting that we still have missed opportunities to diagnose earlier through testing. “

Co-author Andrea Roalfe, senior researcher in medical statistics at the University of Oxford, added:We found that although the rates of NP testing increased over time – with a significant upward trend in 2010 when NICE stepped up its recommendation to do this test – the proportion of patients without NP testing prior to diagnosis remained high and most new diagnoses were made without NP testing. . ‘


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