RT Journal Article
SR Electronic
T1 Diagnostic triage and the role of natriuretic peptide testing and echocardiography for suspected heart failure: an appropriateness ratings evaluation by UK GPs
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e427
OP e435
DO 10.3399/bjgp11X583218
VO 61
IS 588
A1 Stephen M Campbell
A1 Ahmet Fuat
A1 Nick Summerton
A1 Neil Lancaster
A1 FD Richard Hobbs
YR 2011
UL http://bjgp.org/content/61/588/e427.abstract
AB Background Some UK GPs are acquiring access to natriuretic peptide (NP) testing or echocardiography as diagnostic tests for heart failure. This study developed appropriateness ratings for the diagnostic application of these tests in routine general practice.Aim To develop appropriateness ratings for the diagnostic application of NP testing or echocardiography for heart failure in general practice.Design and setting An appropriateness ratings evaluation in UK general practice.Method Four presenting symptoms (cough, bilateral ankle swelling, dyspnoea, fatigue), three levels of risk of cardiovascular disease (low, intermediate, high), and dichotomous categorisations of cardiovascular/chest examination and electrocardiogram result, were used to create 540 appropriateness scenarios for patients in whom NP testing or echocardiography might be considered. These were rated by a 10-person expert panel, consisting of GPs and GPs with specialist interests in cardiology, in a two-round RAND Appropriateness Method.Results Onward referral for NP testing or echocardiography was rated as an appropriate next step in 217 (40.2%) of the 540 scenarios; in 194 (35.9%) it was rated inappropriate. The ratings also show where NP testing or echocardiography were ranked as equivalent next steps and when one test was seen as the more appropriate than the other.Conclusion NP testing should be the routine test for suspected heart failure where referral for diagnostic testing is considered appropriate. An abnormal electrocardiogram status makes referral to echocardiography an accompanying, or more appropriate, next step alongside NP testing, especially in the presence of dyspnoea. Abnormal NP testing should subsequently be followed up with referral for echocardiography.