Lack of BNP testing causing pressure on echocardiography services
By Nigel Praities
A ‘scandalous' lack of provision of B-type natriuretic peptide testing in primary care is putting extra pressure on echocardiography services, researchers warn.
A new analysis has found BNP testing produces far fewer false positives than ECG, easing pressure on secondary care and saving the NHS cash.
The researchers called for a change in NICE guidelines to ramp up pressure on PCTs to provide the test.
Their study, published in the British Journal of Cardiology this month, modelled a hypothetical cohort of 1,000 patients, based on data from three clinical trials.
It forecast BNP would produce 185 false positives referred for echocardiography, compared with 264 with ECG testing. This more efficient triage of patients to echocardiography cost only £0.62 extra per patient, compared with the cost of ECG, and boosted the numbers of correct diagnoses achieved.
But a second study, based on data from 225 of the old PCTs in 2005, found that only a quarter of trusts were then providing access to BNP tests.
Professor Martin Cowie, an author of the first study and chair of the British Society for Heart Failure, said all the evidence showed BNP was the best triage test for echocardiography. ‘BNP testing should be available for every GP in the country as it is the single best test for working out whether patients have heart failure or not. It is really a scandal that it hasn't been so far,' he said.
Professor Cowie criticised guidance from NICE on this issue, which said BNP should be used by GPs ‘where available'. He said he would seek to change this when he chaired the review of these guidelines in 2009 and had just finished working on a Health Technology Assessment looking at this.
Dr Ahmet Fuat, a cardiology GPSI in Darlington who runs a specialist heart failure clinic, said that while BNP testing had good prognostic value, he was ‘ambivalent' about calls for it to be rolled out across the country.
‘This will make me unpopular among some cardiologists, but the fact is we don't have the evidence base yet, and we need a study based in primary care,' he said.
Professor Cowie said Dr Fuat's views were ‘extremely negative' and that he was at ‘one extreme end of opinion' on the issue.Echocardiography services are being put under pressure by a 'scandalous' lack of BNP testing Echocardiography services are being put under pressure by a 'scandalous' lack of BNP testing How BNP compares with ECG