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Three in four heart failure patients not getting natriuretic peptide test before diagnosis



Despite a rise in use of natriuretic peptide (NP) testing in general practice, tests are still not being done in three out of four people before they are diagnosed with heart failure, a study has shown.

It suggests there may be more opportunities to catch the disease at an earlier stage, researchers from the University of Oxford said.

Analysis of data from more than a 1,000 GP surgeries between 2004 and 2018 showed the number of NP tests being done rose from 712 to 48,832 per year with a particular increase after the NICE 2010 updated heart failure guidance.

But only one in four people with heart failure received an NP test in the six months before their diagnosis, meaning many could still be diagnosed at an earlier stage, the researchers concluded in the European Heart Journal.

In 2004 99.6% of patients had no NP testing prior to their heart failure diagnosis but by 2017 this had changed to 76.7%, the analysis shows.

There were no inequalities in testing related to sex or ethnicity, the data showed and more testing is being done in older age groups and in more deprived populations where you would expect higher rates of heart failure.

The researchers did note that previous research has shown some patients can normalise their symptoms until they were severe enough to have a substantial impact on their daily activities.

But they said greater public awareness, a higher index of suspicion for heart failure in primary care and an increase in NP testing in those with symptoms such as breathlessness, fatigue and ankle swelling is needed to boost early diagnosis.

Study lead Dr Clare Taylor, a GP and NIHR academic clinical lecturer at the University of Oxford, said heart failure affects one million people in the UK.

‘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.

‘As GPs we can do a simple blood test in primary care which tells us if heart failure is likely. The heart failure detection rate in our study over a 14-year period remained the same, suggesting there are still missed opportunities for us to diagnose sooner through testing.’

Co-author Andrea Roalfe, a senior researcher in medical statistics at the University of Oxford, added: ‘We found that whilst NP test rates increased over time – with a significant upward trend in 2010 when NICE strengthened their recommendation to do this testing – the proportion of patients without NP testing prior to diagnosis remained high and most new diagnoses were made without an NP test.’