Diagnosing heart failure in primary care – what cut offs should GPs be using for referral based on natriuretic peptide levels?

Today, we talk to Dr Claire Taylor, a GP and NIHR Clinical Lecturer at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Paper: Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy studyAvailable at : https://doi.org/10.3399/BJGP.2022.0278International guidelines recommend natriuretic peptide (NP) testing to prioritise referral for heart failure (HF) diagnostic assessment in primary care. European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guidelines differ significantly in their recommended NP referral threshold. Our study found at the lower ESC threshold fewer HF diagnoses were missed but more referrals from primary care would be required. Healthcare systems need to balance the risk of a missed or delayed diagnosis for individual patients with capacity in diagnostic services. An NP level below both the ESC and NICE thresholds was reliable in ruling out HF.