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At the heart of general practice since 1960

Act now over the plight of overseas doctors

Your report 'Study hits hopes for LVSD screening' (News, August 16) states BNP can exclude 'only 40 per cent' of patients from further assessment – I for one would call that jolly useful!

We are not screening a healthy population in general practice, but we do have to refer all cases of 'suspected heart failure' for echo, according to our quality framework. Many GPs would start an ACE inhibitor while waiting.

The NICE guideline makes the useful cost-effective point that a normal ECG and a normal BNP effectively excludes heart failure and so the need for echo.

The pressure for echocardiograms where I live is enormous so an £8 BNP test that enables GPs to exclude heart failure diagnosis in a suspect case, avoid ACE inhibitor prescription, and avoid referral has got to be real NHS value for money!

Dr LS Lewis



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