Point-of-care NT-proBNP monitoring for heart failure: observational feasibility study in primary care

Jason Chami; Susannah Fleming; Clare J. Taylor; Clare R Bankhead; Tim James; Brian Shine; Julie McLellan; FD Richard Hobbs; Rafael Perera

doi:10.3399/BJGPO.2022.0005

Point-of-care NT-proBNP monitoring for heart failure: observational feasibility study in primary care

Jason Chami^*, Susannah Fleming, Clare J. Taylor, Clare R Bankhead, Tim James, Brian Shine, Julie McLellan, FD Richard Hobbs, Rafael Perera

^*Corresponding author for this work

Applied Health Research

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Abstract

Background: Around one million individuals in the UK have heart failure (HF), a chronic disease that causes significant morbidity and mortality. N-terminal pro-B-type natriuretic peptide (NT-proBNP) monitoring could help improve the care of patients with HF in the community.

Aim: The aim of this study is to provide evidence to support the routine use of point-of-care (POC) NT-proBNP monitoring in primary care.

Design & setting: In this observational cohort study, the Roche Cobas h 232 POC device was used to measure NT-proBNP in 27 patients with HF at 0, 6, and 12 months, with a subset reanalysed in the laboratory for comparison.

Method: Data were analysed for within-person and between-person variability and concordance with laboratory readings using Passing–Bablok regression. GPs reported whether POC results impacted clinical decisionmaking, and patients indicated their willingness to participate in long-term cohort studies using the Likert acceptability scale.

Results: Within-person variability in POC NT-proBNP over 12 months was 881 pg/mL (95% confidence interval [CI] = 380 to 1382 pg/mL). Between-person variability was 1972 pg/mL (95% CI = 1,525 to 2791 pg/mL). Passing–Bablok regression showed no significant systematic difference between POC and laboratory measurements. Patients indicated a high level of acceptability, and GP decisionmaking was affected for at least one visit in a third of patients.

Conclusion: Within-person variability in POC NT-proBNP is around half of between-person variability, so detecting changes could be of use in HF management. High patient acceptability and impact on clinical decisionmaking warrant further investigation in a larger long-term cohort study.

Original language	English
Article number	BJGPO.2022.0005
Number of pages	10
Journal	BJGP Open
Volume	6
Issue number	3
DOIs	https://doi.org/10.3399/BJGPO.2022.0005
Publication status	Published - 28 Sept 2022

Bibliographical note

Funding Information:
This study is funded by the NIHR Programme Grants for Applied Research programme (Reference: RP-PG-1210– 12003). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. CT is a NIHR-funded Academic Clinical Lecturer. FDRH acknowledges part support from the NIHR School for Primary Care Research. CRB, FDRH, and RP acknowledge part support from the NIHR Applied Research Collaboration Oxford & Thames Valley, and the NIHR Oxford Biomedical Research Centre. RP also acknowledges part-funding from the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative and the Oxford Martin School.

The authors would like to thank the clinicians and patients of White Horse Medical Practice, Sum-mertown Health Centre, and Bicester Health Centre, without whom this study could not have taken place. The research team acknowledges the support of the National Institute for Health Research (NIHR) Clinical Research Network. The authors would also like to thank Laura Hill, Elizabeth Hollo- way and Marion Judd, for their input into the study design, Kristy Ravenhall and Alice Fuller for data entry support, and Richard Stevens for statistical advice.

Publisher Copyright:
© 2022, The Authors

Keywords

Brain natriuretic peptide
Family practice
General practice
Heart failure
Point-of-care testing
Primary health care

ASJC Scopus subject areas

Family Practice

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Cite this

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title = "Point-of-care NT-proBNP monitoring for heart failure: observational feasibility study in primary care",

abstract = "Background: Around one million individuals in the UK have heart failure (HF), a chronic disease that causes significant morbidity and mortality. N-terminal pro-B-type natriuretic peptide (NT-proBNP) monitoring could help improve the care of patients with HF in the community. Aim: The aim of this study is to provide evidence to support the routine use of point-of-care (POC) NT-proBNP monitoring in primary care. Design & setting: In this observational cohort study, the Roche Cobas h 232 POC device was used to measure NT-proBNP in 27 patients with HF at 0, 6, and 12 months, with a subset reanalysed in the laboratory for comparison. Method: Data were analysed for within-person and between-person variability and concordance with laboratory readings using Passing–Bablok regression. GPs reported whether POC results impacted clinical decisionmaking, and patients indicated their willingness to participate in long-term cohort studies using the Likert acceptability scale. Results: Within-person variability in POC NT-proBNP over 12 months was 881 pg/mL (95% confidence interval [CI] = 380 to 1382 pg/mL). Between-person variability was 1972 pg/mL (95% CI = 1,525 to 2791 pg/mL). Passing–Bablok regression showed no significant systematic difference between POC and laboratory measurements. Patients indicated a high level of acceptability, and GP decisionmaking was affected for at least one visit in a third of patients. Conclusion: Within-person variability in POC NT-proBNP is around half of between-person variability, so detecting changes could be of use in HF management. High patient acceptability and impact on clinical decisionmaking warrant further investigation in a larger long-term cohort study.",

keywords = "Brain natriuretic peptide, Family practice, General practice, Heart failure, Point-of-care testing, Primary health care",

author = "Jason Chami and Susannah Fleming and Taylor, {Clare J.} and Bankhead, {Clare R} and Tim James and Brian Shine and Julie McLellan and Hobbs, {FD Richard} and Rafael Perera",

note = "Funding Information: This study is funded by the NIHR Programme Grants for Applied Research programme (Reference: RP-PG-1210– 12003). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. CT is a NIHR-funded Academic Clinical Lecturer. FDRH acknowledges part support from the NIHR School for Primary Care Research. CRB, FDRH, and RP acknowledge part support from the NIHR Applied Research Collaboration Oxford & Thames Valley, and the NIHR Oxford Biomedical Research Centre. RP also acknowledges part-funding from the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative and the Oxford Martin School. The authors would like to thank the clinicians and patients of White Horse Medical Practice, Sum-mertown Health Centre, and Bicester Health Centre, without whom this study could not have taken place. The research team acknowledges the support of the National Institute for Health Research (NIHR) Clinical Research Network. The authors would also like to thank Laura Hill, Elizabeth Hollo- way and Marion Judd, for their input into the study design, Kristy Ravenhall and Alice Fuller for data entry support, and Richard Stevens for statistical advice. Publisher Copyright: {\textcopyright} 2022, The Authors",

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AU - Fleming, Susannah

AU - Taylor, Clare J.

AU - Bankhead, Clare R

AU - James, Tim

AU - Shine, Brian

AU - McLellan, Julie

AU - Hobbs, FD Richard

AU - Perera, Rafael

N1 - Funding Information: This study is funded by the NIHR Programme Grants for Applied Research programme (Reference: RP-PG-1210– 12003). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. CT is a NIHR-funded Academic Clinical Lecturer. FDRH acknowledges part support from the NIHR School for Primary Care Research. CRB, FDRH, and RP acknowledge part support from the NIHR Applied Research Collaboration Oxford & Thames Valley, and the NIHR Oxford Biomedical Research Centre. RP also acknowledges part-funding from the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative and the Oxford Martin School. The authors would like to thank the clinicians and patients of White Horse Medical Practice, Sum-mertown Health Centre, and Bicester Health Centre, without whom this study could not have taken place. The research team acknowledges the support of the National Institute for Health Research (NIHR) Clinical Research Network. The authors would also like to thank Laura Hill, Elizabeth Hollo- way and Marion Judd, for their input into the study design, Kristy Ravenhall and Alice Fuller for data entry support, and Richard Stevens for statistical advice. Publisher Copyright: © 2022, The Authors

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N2 - Background: Around one million individuals in the UK have heart failure (HF), a chronic disease that causes significant morbidity and mortality. N-terminal pro-B-type natriuretic peptide (NT-proBNP) monitoring could help improve the care of patients with HF in the community. Aim: The aim of this study is to provide evidence to support the routine use of point-of-care (POC) NT-proBNP monitoring in primary care. Design & setting: In this observational cohort study, the Roche Cobas h 232 POC device was used to measure NT-proBNP in 27 patients with HF at 0, 6, and 12 months, with a subset reanalysed in the laboratory for comparison. Method: Data were analysed for within-person and between-person variability and concordance with laboratory readings using Passing–Bablok regression. GPs reported whether POC results impacted clinical decisionmaking, and patients indicated their willingness to participate in long-term cohort studies using the Likert acceptability scale. Results: Within-person variability in POC NT-proBNP over 12 months was 881 pg/mL (95% confidence interval [CI] = 380 to 1382 pg/mL). Between-person variability was 1972 pg/mL (95% CI = 1,525 to 2791 pg/mL). Passing–Bablok regression showed no significant systematic difference between POC and laboratory measurements. Patients indicated a high level of acceptability, and GP decisionmaking was affected for at least one visit in a third of patients. Conclusion: Within-person variability in POC NT-proBNP is around half of between-person variability, so detecting changes could be of use in HF management. High patient acceptability and impact on clinical decisionmaking warrant further investigation in a larger long-term cohort study.

AB - Background: Around one million individuals in the UK have heart failure (HF), a chronic disease that causes significant morbidity and mortality. N-terminal pro-B-type natriuretic peptide (NT-proBNP) monitoring could help improve the care of patients with HF in the community. Aim: The aim of this study is to provide evidence to support the routine use of point-of-care (POC) NT-proBNP monitoring in primary care. Design & setting: In this observational cohort study, the Roche Cobas h 232 POC device was used to measure NT-proBNP in 27 patients with HF at 0, 6, and 12 months, with a subset reanalysed in the laboratory for comparison. Method: Data were analysed for within-person and between-person variability and concordance with laboratory readings using Passing–Bablok regression. GPs reported whether POC results impacted clinical decisionmaking, and patients indicated their willingness to participate in long-term cohort studies using the Likert acceptability scale. Results: Within-person variability in POC NT-proBNP over 12 months was 881 pg/mL (95% confidence interval [CI] = 380 to 1382 pg/mL). Between-person variability was 1972 pg/mL (95% CI = 1,525 to 2791 pg/mL). Passing–Bablok regression showed no significant systematic difference between POC and laboratory measurements. Patients indicated a high level of acceptability, and GP decisionmaking was affected for at least one visit in a third of patients. Conclusion: Within-person variability in POC NT-proBNP is around half of between-person variability, so detecting changes could be of use in HF management. High patient acceptability and impact on clinical decisionmaking warrant further investigation in a larger long-term cohort study.

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Point-of-care NT-proBNP monitoring for heart failure: observational feasibility study in primary care

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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