'Costlier' BNP no better than ECG
BNP testing is no better than ECG for diagnosing heart failure and struggles to justify its extra cost, a new meta-analysis concludes.
By Emma Wilkinson
Combining the two tests also gives little improvement in diagnostic accuracy, the researchers found.
The study, published in the British Journal of General Practice (January), suggests NICE may have been premature in encouraging greater use of BNP in its 2003 guidance on heart failure.
Researchers analysed 32 studies on BNP and ECG in heart failure and found both tests were equally good with sensitivities of more than 80 per cent. A combination of the two tests had no significant effect on sensitivity and 'limited evidence' of improvement in specificity.
But the researchers estimated that ECG cost just £10 per patient, compared with £20 per patient for BNP.
Study leader Dr Clare Davenport, clinical research fellow in the department of public health and epidemiology at the University of Birmingham, said: 'There is currently no evidence to justify the use of one test over another or the use of tests in combination.'
She added: 'The additional cost of BNP testing is not self-evidently justified by improved test accuracy.'
NICE recommended excluding heart failure through 12-lead ECG and/or natriuretic peptides where available leaving it unclear whether BNP should be used in addition to or instead of ECG.
Dr Ahmet Fuat, a GP in Darlington and GP specialist in cardiology at Darlington Memorial Hospital, said: 'Most GPs are not clear about the best way to triage patients so there's still confusion around that.
'Cardiologists would say you need an ECG. If a patient has a normal ECG but you still have concerns maybe BNP would be appropriate at that point.'
Dr Fuat, who is also deputy chair of the Primary Care Cardiovascular Society, admitted BNP cost was a barrier to its use, but said many GPs needed specialist help in interpreting ECGs.
Dr John Pittard, a GP in Staines, Middlesex, who was involved in drawing up the national service framework on CHD, doubted whether there was such a difference in cost between ECG and BNP.
'It should be possible through PCT commissioning to get the unit cost of BNP down,' he said.