TY - JOUR T1 - Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy study JF - British Journal of General Practice JO - Br J Gen Pract DO - 10.3399/BJGP.2022.0278 SP - BJGP.2022.0278 AU - Clare J Taylor AU - Jose Ordóñez-Mena AU - Sarah Lay-Flurrie AU - Clare Goyder AU - Kathryn Taylor AU - Nicholas Robert Jones AU - Andrea Roalfe AU - FD Richard Hobbs Y1 - 2022/11/01 UR - http://bjgp.org/content/early/2022/11/01/BJGP.2022.0278.abstract N2 - Background: Natriuretic peptide (NP) testing is recommended for patients presenting to primary care with symptoms of chronic heart failure (HF) to prioritise referral for diagnosis. Aim: To report NP test performance at European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guideline referral thresholds. Design and Setting: Diagnostic accuracy study using linked primary and secondary care data (2004-2018). Methods: Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of NP test for HF diagnosis. Results: 229,580 patients had a NP test and 21,102 (9.2%) were diagnosed with HF within six months. The ESC NT-proBNP threshold ≥125pg/ml had a sensitivity of 94.6% (95% confidence interval 94.2 to 95.0), and specificity 50.0% (49.7 to 50.3) compared to sensitivity of 81.7% (81.0 to 82.3) and specificity of 80.3% (80.0 to 80.5) for the NICE NT-proBNP ≥400pg/ml threshold. PPVs for a NT-proBNP test were 16.4% (16.1 to 16.6) and 30.0% (29.6 to 30.5) for ESC and NICE thresholds, respectively. For both guidelines, nearly all patients with a NT-proBNP level below the threshold did not have HF (NPV: ESC 98.9% (98.8 to 99.0) and NICE 97.7% (97.6 to 97.8). Conclusions: At 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. ER -