New research published today in the European Heart Journal suggests that three quarters of patients with heart failure (HF) could be diagnosed earlier with more natriuretic peptide (NP) testing in UK primary care. The study found that despite an increase in NP testing in primary care over time, most patients with newly diagnosed HF have not had the NP test.
Emphasising the importance of NP testing, Dr Clare Taylor, GP and Lecturer at the University of Oxford's Nuffield Department of Primary Care Health Sciences, said: “As a GP I often see patients with heart failure. There are 200,000 new cases each year, and around 80% of these patients are only diagnosed when they are so unwell they’ve needed to be admitted to hospital. There are many treatments that improve both quality of life and survival, but we need to give them earlier so patients benefit sooner and avoid hospitalisation, which is why this testing is so important.”
Researchers at the University of Oxford conducted a retrospective cohort study using data from the Clinical Practice Research Datalink Gold and Aurum databases between 2004 and 2018. The study included 7,212,013 individuals aged ≥45 years in England with an overall follow-up of 48,354,892 person-years.
There was a significant increase in NP test rates from 0.25 per 1000 person-years in 2004 to 16.88 per 1000 person-years in 2018. The upward trend particularly gained momentum in 2010 after national guidance on HF was published.
There were no disparities in NP testing with reference to sex and ethnicity. NP testing rates were higher in older age groups and more socially deprived groups, which was expected due to an increased risk of HF in these populations.
The proportion of patients who did not undergo NP testing prior to HF diagnosis decreased from 99.6% in 2004 to 76.7% in 2017. The proportion of tests resulting in an HF diagnosis within 6 months remained stable (around 10%) over the study period and the positive predictive values for an NP test above the referral threshold set by National Institute for Health and Care Excellence did not change significantly over time (from 28.1% in 2008 to 29.5% in 2017).
The authors believe there has been inadequate progress with NP testing in primary care over time, and patients presenting with less overt signs and symptoms of HF are still likely to remain untested. They call for greater NP testing from GPs to aid earlier diagnosis of HF at a more treatable stage.
The research was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford.