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  3. Reliability of N-terminal pro-brain natriuretic peptide assay in diagnosis of heart failure: cohort study in representative and high risk community populations
Primary Care

Reliability of N-terminal pro-brain natriuretic peptide assay in diagnosis of heart failure: cohort study in representative and high risk community populations

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7352.1498 (Published 22 June 2002) Cite this as: BMJ 2002;324:1498
  1. F D R Hobbs (f.d.r.hobbs{at}bham.ac.uk), head of departmenta,
  2. R C Davis, clinical research fellowa,
  3. A K Roalfe, statisticiana,
  4. R Hare, research associatea,
  5. M K Davies, consultant cardiologistb,
  6. J E Kenkre, senior research fellowa
  1. a Department of Primary Care and General Practice, Primary Care Clinical Sciences Building, University of Birmingham, Birmingham B15 2TT
  2. b Department of Cardiology, Selly Oak Hospital, Birmingham B29 2PE
  1. Correspondence to: F D R Hobbs
  • Accepted 4 April 2002

Abstract

Objective: To investigate the performance of a novel assay for N-terminal pro-brain natriuretic peptide (NT-proBNP) in diagnosing heart failure in various randomly selected general and high risk community populations.

Design: Community cohort study (substudy of the echocardiographic heart of England screening study).

Setting: Four randomly selected general practices in the West Midlands of England.

Participants: 591 randomly sampled patients over the age of 45, stratified for age and socioeconomic status and falling into four cohorts (general population, patients with an existing clinical label of heart failure, patients prescribed diuretics, and patients deemed at high risk of heart failure).

Main outcome measure: Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and area under receiver operating characteristic curve for NT-proBNP assay in the diagnosis of heart failure.

Results: For NT-proBNP in the diagnosis of heart failure in the general population (population screen), a level of >36 pmol/l had a sensitivity of 100%, a specificity of 70%, a positive predictive value of 7%, a negative predictive value of 100%, and an area under the receiver operating characteristic curve of 0.92 (95% confidence interval 0.82 to 1.0). Similar negative predictive values were found for patients from the three other populations screened.

Conclusions: This NT-proBNP assay seems to have value in the diagnosis of heart failure in the community. High negative predictive values indicate that the assay's chief use would be to rule out heart failure in patients with suspected heart failure with normal concentrations of NT-proBNP. Positive results may identify patients who need cardiac imaging.

Footnotes

  • Funding The ECHOES study was funded by the NHS R&D cardiovascular disease and stroke programme. The costs of collecting and handling the samples were supported by an NHS Regional R&D grant, and the assays and technical support were donated by J Trawinski and J Baumann of Roche Diagnostic Solutions.

  • Competing interests FDRH is a member of the European Society of Cardiology (ESC) Working Party on Heart Failure, chair of the British Primary Care Cardiovascular Society, and Treasurer of the British Society for Heart Failure. MKD is chairman of the British Society for Heart Failure. FDRH and MKD have received travel sponsorship and honorariums from several biotechnology and pharmaceutical companies with cardiovascular products for plenary talks and attendance at major cardiology scientific congresses and conferences.

  • Accepted 4 April 2002
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