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GP BNP tests effective

By Emma Wilkinson

Natriuretic peptide testing in primary care effectively excludes heart failure and can cut GP referrals by a quarter, a new study concludes.

The researchers said their study was the first to demonstrate that both NT Pro-BNP and BNP testing were effective in a general practice setting.

NT Pro-BNP performed slightly better than BNP testing, with a negative predictive value of 92 per cent.

Study leader Dr Ahmet Fuat, a GPSI in cardiology in Darlington, County Durham, said: 'In our BJGP study BNP and NT pro-BNP both performed better than ECG in selection of patients for assessment of left ventricular function.'

The study of 297 consecutive GP referrals, published in the BJGP this week, estimated testing with a NT Pro-BNP cut-off of 150pg/ml would reduce referrals to a heart failure clinic by 25 per cent.

Researchers are planning further research to examine whether a threshold of 300pg/ml could reduce numbers of false positives.

A survey by the same research group, presented at the British Cardiac Society conference in Glasgow this week, found GPs favoured triage with NT Pro-BNP to ECG for diagnosing heart failure.

Some 49 per cent of GPs were confident at interpreting NT Pro-BNP tests, compared with only 23 per cent for ECG.

GPs' preferred model of care for heart failure diagnosis combined NT Pro-BNP triage with use of open-access heart fail-

ure clinics run by GP specialists.

Dr Fuat added: 'GPs also liked triage with NT pro-BNP.

A lot of GPs are not very confident with ECG but with NT pro-BNP it gives you a numerical

value ­ it's not open to inter- pretation.'

Dr Fuat said the GP survey results strengthened the case for specialist clinics in the NHS. 'Most GPs preferred the one- stop diagnosis clinic to open-

access echo because our waiting lists were shorter and they got a full assessment and full report from me.'

Dr Gerald Partridge, a GP in Keighley, West Yorkshire, who runs an echocardiography clinic in his practice, said GPs preferred to have feedback from a specialist or GPSI whatever the type of service.

'I do an echo and give my opinion on the diagnosis. People come and see the person doing the echo and the doctor at the same time and I write back with an opinion.'

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