GPs should use BNP testing and a list of clinical features, rather than ECGs, to determine whether a patient with suspected heart failure needs to be referred for an echocardiogram, concludes a UK analysis.
The authors looked at five primary care studies that evaluated clinical features and investigations predictive of heart failure, and then formed different models predicting heart failure.
Of the models tested, they found that using clinical features of a myocardial infarction - crepitations, ankle oedema plus a measure of BNP or NT-pro BNP - had the best predictive value.
The discrimination of these features for heart failure was very good compared with other models, as measured by values for ‘area under the receiver operating characteristic curve' that were between 0.84 and 0.93.
There was between 90% to 96% sensitivity for the NT-pro BNP plus clinical features model and between 81% to 89% for the BNP plus clinical features model.
The study authors from the University of Birmingham, concluded: ‘Natriuretic peptide testing should be recommended over ECG. Some patients could be referred for early echocardiography without undergoing preliminary investigation.'
European Journal of Heart Failure, available online 19 June 2012
