Abstract
Aims: Heart failure (HF) is a malignant condition with poor outcomes and is often diagnosed on emergency hospital admission. Natriuretic peptide (NP) testing in primary care is recommended in international guidelines to facilitate timely diagnosis. We aimed to report contemporary trends in NP testing and subsequent HF diagnosis rates over time.
Methods and results: Cohort study using linked primary and secondary care data of adult (≥45 years) patients in England 2004-18 (n = 7 212 013, 48% male) to report trends in NP testing (over time, by age, sex, ethnicity, and socioeconomic status) and HF diagnosis rates. NP test rates increased from 0.25 per 1000 person-years [95% confidence interval (CI) 0.23-0.26] in 2004 to 16.88 per 1000 person-years (95% CI 16.73-17.03) in 2018, with a significant upward trend in 2010 following publication of national HF guidance. Women and different ethnic groups had similar test rates, and there was more NP testing in older and more socially deprived groups as expected. The HF detection rate was constant over the study period (around 10%) and the proportion of patients without NP testing prior to diagnosis remained high [99.6% (n = 13 484) in 2004 vs. 76.7% (n = 12 978) in 2017].
Conclusion: NP testing in primary care has increased over time, with no evidence of significant inequalities, but most patients with HF still do not have an NP test recorded prior to diagnosis. More NP testing in primary care may be needed to prevent hospitalization and facilitate HF diagnosis at an earlier, more treatable stage.
| Original language | English |
|---|---|
| Pages (from-to) | 881-891 |
| Number of pages | 11 |
| Journal | European Heart Journal |
| Volume | 43 |
| Issue number | 9 |
| Early online date | 30 Nov 2021 |
| DOIs | |
| Publication status | Published - 1 Mar 2022 |
Bibliographical note
Funding:The study was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford. The funders did not have any role in the design of the study, analysis and interpretation of the data, or writing of the results for publication. C.J.T. is a National Institute for Health Research (NIHR) Academic Clinical Lecturer. A.K.R., S.L.L.-F., and J.M.O.-M. are supported by the NIHR Oxford Biomedical Research Centre (BRC) and NIHR Applied Research Collaborative (ARC) Oxford and Thames Valley. F.D.R.H. acknowledges support from the NIHR School for Primary Care Research, NIHR ARC Oxford and Thames Valley, and the NIHR Oxford BRC. C.R.G. is funded by a Wellcome Trust Fellowship (grant no. 203921). NJ is a Wellcome Trust Doctoral Research Fellow (grant no. 203921/Z/16/Z). This work is part of the NIHR Community Healthcare Medtech and In Vitro Diagnostics Cooperative (MIC) long-term conditions theme led by C.J.T. and F.D.R.H. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognizes and values the role of patient data, securely accessed, and stored, both in underpinning and leading to improvements in research and care. All authors had full access to the full data in the study and accept responsibility to submit for publication.
Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
Keywords
- Diagnosis
- Heart failure
- Natriuretic peptide
- Testing
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine