Evidence map›Paper›PMID 36543554›Full record

ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2023

Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy study.

Clare J Taylor, José M Ordóñez-Mena, Sarah L Lay-Flurrie, Clare R Goyder, Kathryn S Taylor, Nicholas R Jones, Andrea K Roalfe, Fd Richard Hobbs

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 2 pooled it
3.6field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 27 citations in OpenAlex.

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  16. Earlier heart failure diagnosis in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

Clare J TaylorNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.ORCID 0000-0001-8926-2581
José M Ordóñez-MenaNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.ORCID 0000-0002-8965-104X
Sarah L Lay-FlurrieNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.ORCID 0000-0003-1094-8455
Clare R GoyderNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.ORCID 0000-0002-7461-9661
Kathryn S TaylorNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.ORCID 0000-0001-6589-5456
Nicholas R JonesNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.ORCID 0000-0002-0352-3785
Andrea K RoalfeNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.ORCID 0000-0003-1622-2639
Fd Richard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.ORCID 0000-0001-7976-7172
University of Oxford · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNatriuretic peptide (NP) testing is recommended for patients presenting to primary care with symptoms of chronic heart failure (HF) to prioritise referral for diagnosis.

aimTo report NP test performance at European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guideline referral thresholds. DESIGN AND

settingDiagnostic accuracy study using linked primary and secondary care data (2004 to 2018).

methodThe sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NP testing for HF diagnosis was assessed.

resultsIn total, 229 580 patients had an NP test and 21 102 (9.2%) were diagnosed with HF within 6 months. The ESC NT-proBNP threshold ≥125 pg/mL had a sensitivity of 94.6% (95% confidence interval [CI] = 94.2 to 95.0) and specificity of 50.0% (95% CI = 49.7 to 50.3), compared with sensitivity of 81.7% (95% CI = 81.0 to 82.3) and specificity of 80.3% (95% CI = 80.0 to 80.5) for the NICE NT-proBNP ≥400 pg/mL threshold. PPVs for an NT-proBNP test were 16.4% (95% CI = 16.1 to 16.6) and 30.0% (95% CI = 29.6 to 30.5) for ESC and NICE thresholds, respectively. For both guidelines, nearly all patients with an NT-proBNP level below the threshold did not have HF (NPV: ESC 98.9%, 95% CI = 98.8 to 99.0 and NICE 97.7%, 95% CI = 97.6 to 97.8).

conclusionAt the higher NICE chronic HF guideline NP thresholds, one in five cases are initially missed in primary care but the lower ESC thresholds require more diagnostic assessments. NP is a reliable 'rule-out' test at both cut-points. The optimal NP threshold will depend on the priorities and capacity of the healthcare system.

Indexed as

Heart FailureBiomarkersChronic DiseaseHumansNatriuretic Peptide, BrainPeptide FragmentsPredictive Value of TestsPrimary Health CareReferral and ConsultationSecondary Health CareBiomarkersNatriuretic Peptide, BrainPeptide Fragmentsdiagnosisheart failurenatriuretic peptideprimary caretesting

Identifiers

PMID36543554
PMCPMC9799346
OpenAlexW4308006057

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.