NIHR Academic Clinical Lecturer and GP Dr Clare Taylor gives a breakdown of the findings and their importance of a recent publication on heart failure and natriuretic peptide testing by herself and colleagues.
Heart failure is a malignant condition affecting almost a million people in the UK and has a worse prognosis than most cancers. Our analysis, published in the BMJ in 2019, showed that survival rates had not substantially improved in the previous two decades. Around 200,000 people receive a new diagnosis of heart failure each year and a recent British Heart Foundation report suggests there are significant delays in the current diagnostic pathway.
The National Institute for Health and Care Excellence (NICE) recommend a natriuretic peptide (NP) blood test for anyone presenting to primary care with symptoms of heart failure. If the level is raised, the patient requires referral for echocardiography and cardiology assessment. NICE recommend this should be completed within two weeks if the NP level is high (NT-proBNP>2000pg/ml).
In our study published today in Heart, we used linked primary and secondary care data from 40,000 patients with a new heart failure diagnosis to assess the association between initial NP result and subsequent hospitalisation and death.
Over half of patients were admitted to hospital in the year following diagnosis overall with a two-fold higher risk of admission due to heart failure in people with a high NP level. Death from any cause was also greater in the high NP group, with heart failure-related death 50% higher at 1, 5 and 10 years. The time from NP blood test to diagnosis was outside guideline recommended limits.
People with a high NP level in primary care are at increased risk of being admitted to hospital due to heart failure and have worse survival in the short and long term. These patients need to be diagnosed and treated quickly.
GPs currently have access to a ‘two-week wait’ referral pathway for patients with cancer symptoms. A similar compulsory two-week target may be needed for people with a high NP to facilitate timely heart failure diagnosis, and potentially reduce hospitalisations and improve survival.
This work was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust , and the NIHR Community Healthcare Medtech and In Vitro Diagnostics Co-operative, Oxford.