Action on elevated natriuretic peptide in primary care: a retrospective cohort study

BACKGROUND: Natriuretic peptides (NPs) are released by increased ventricular wall stress, most often caused by heart failure (HF). NP level measurement helps select patients clinically suspected of HF who need echocardiography. Yet, the diagnostic actions following NP testing in daily primary care are poorly studied.

AIM: To assess the diagnostic actions taken by GPs in patients with an elevated NP level.

DESIGN & SETTING: Retrospective observational study in general practices in The Netherlands.

METHOD: In patients with an elevated NP level between July 2017 and July 2022, diagnostic actions were collected during 3 months following NP testing. We compared patients with an elevated NP level referred for echocardiography with those not referred by univariable analyses.

RESULTS: Among 902 patients, 394 (43.7%) had an elevated NP level. Median age was 75.0 (interquartile range [IQR] 18.0) years; 68.8% were female. In total, 166 (42.1%) were referred for echocardiography and 114 (28.9%) underwent additional electrocardiogram (ECG) recording. In total, n = 30/166 (18.1%) referred patients were labelled HF by the cardiologist within 3 months after NP testing compared with n = 29/228 (12.7%) not referred. Referred patients were compared with those not referred and they were found to be younger (69.7 versus 74.1 years, P<0.001), were less often known to cardiologists (45.8% versus 62.3%, P = 0.002), and they had lower marginally elevated B-type natriuretic peptide (BNP) levels (35-50 pg/ml) (19.3% versus 36.6%, P<0.001).

CONCLUSION: Three out of five patients with an elevated NP level are not referred for echocardiography by GPs. Barriers to refer patients were older age, a marginally elevated BNP value, and already being under supervision of a cardiologist.