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NICE set to urge use of heart failure test

The Government is set to urge GPs to use a new diagnostic test to reduce pressure on echocardiography services.

National Institute for Clinical Excellence guidance on heart failure, due this summer, is expected to include a recommendation that GPs exclude heart failure using a blood test for the marker N-terminal pro-brain natriuretic peptide (NT-proBNP).

Professor Martin Cowie, professor of cardiology at the National Heart and Lung Institute in London, hopes the test will help reduce unacceptably long waiting lists for echocardiography, the gold standard test for heart failure.

Professor Cowie, one of the experts drawing up the NICE guidelines, said the test would make a 'huge difference' to primary care and could act as part of a diagnostic triage.

He said: 'The test will really help GPs. When they get patients who come in with breathlessness, if they have a low or normal level it normally means it is not heart failure.'

He added: 'The guidelines will include good advice on health care technologies, including NT-proBNP.'

Improving GP management of heart failure is a

Government priority and the Department of Health is expected to set tough new targets this year, although no funding has been set aside.

New results from the Coronary Heart Disease Collaborative ­ a flagship Government project designed to improve services for CHD patients ­ show dramatic improvements in effective prescribing for heart failure in 300-plus practices.

Over the last 18 months, the proportion of patients with established heart failure prescribed ACE inhibitors leapt from 40 to 85 per cent.

Outpatient waiting times for echocardiography were slashed from 69 to 38 days.

Dr Mark Dancy, consultant cardiologist at Central Middlesex Hospital, London, and clinical chair of the collaborative, said simple organisational changes in managing patients were responsible for the


Dr Mike Kirby, a GP in Letchworth, Hertfordshire, and a member of the Primary Care Cardiovascular Society, said the NT-proBNP test could be used to monitor the effect of medication. If levels remained high the GP should 'push treatment harder'.

He said: 'It allows us to make more practical use of scarce echo services.'

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