Point-of-care B-type natriuretic peptide and portable echocardiography for assessment of patients with suspected heart failure in primary care: rationale and design of the three-part Handheld-BNP program and results of the training study

2017 ◽  
Vol 107 (2) ◽  
pp. 95-107 ◽  
Author(s):  
Caroline Morbach ◽  
◽  
Thomas Buck ◽  
Christian Rost ◽  
Sebastian Peter ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Natriuretic Peptide ◽  
Point Of Care ◽  
Training Study

Abstract 15507: Trajectories of Point of Care B-type Natriuretic Peptide (bnp) and Its Role as a Predictor of All-cause Mortality Among Hiv and Non-hiv Heart Failure Patients in Uganda

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Samson Okello ◽  
Fardous C Abeya
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Point Of Care ◽  
Antiplatelet Agents ◽  
Infected People ◽  
Serial Measurement ◽  
All Cause Mortality ◽  
Hiv Serostatus

Introduction: The usefulness of serial measurement of BNP to reduce hospitalization or mortality in patients with HIV and heartfailure is unknown. Hypothesis: We sought to describe changes in B-type natriuretic peptide (BNP) and estimate the effect of HIV on BNP over a week of observation in an acute heart failure cohort of 40 HIV-infected adults (≥18 years) on antiretroviral therapy (ART) and 175 HIV-uninfected hospitalized patients in Uganda. Methods: We measured BNP using i-STAT BNP (Abbott point of care, Princeton, New Jersey) and compared changes by HIV serostatus, and evaluated BNP as a predictor of all-cause mortality at 30 days from hospitalization using multilevel mixed and competitive risk regression models respectively. Results: Overall HIV-infected participants had a higher mean BNP than HIV-uninfected counterparts. After initial declines in BNP in both groups between day 0 and day 3, BNP moderately increased among the HIV-infected on day 7 and continued to decline in the HIV-uninfected group. Each 1 pg/mL increase in baseline BNP from 400 pg/mL increased the risk of all-cause mortality within 30 days by 1% (adjusted standardized hazard ratio (aSHR) 1.01, 95%CI 1.01, 1.01). Other predictors of increased 30-day all-cause mortality included smoking (aSHR 1.99, 95%CI 1.04, 3.84), hypotension (aSHR 1.69, 95%CI 1.26, 2.26) and renal failure stage 3 (aSHR 2.06, 95%CI 1.34, 3.18), and renal failure stage 5 (aSHR 2.02, 95%CI 1.30, 3.13). We found a lower risk of 30-day all-cause mortality of 38% (95%CI 20%, 73%) for those receiving loop diuretics and 74% (95%CI 56%, 99%) for antiplatelet agents. Conclusions: Over a week of observation, HIV-infected people hospitalized with acute heart failure in Uganda have higher BNP levels than HIV-uninfected counterparts. Increases in BNP above the upper bound of the normal predicted heightened risk of all-cause mortality within 30 days of hospitalization.

scholarly journals Accuracy, user-friendliness and usefulness of the Cobas h232 point-of-care test for NT-proBNP in primary care

2017 ◽  
Vol 71 (6) ◽  
pp. 539-545 ◽  
Author(s):  
Chiel Hex ◽  
Miek Smeets ◽  
Joris Penders ◽  
Viviane Van Hoof ◽  
Jan Verbakel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Linear Regression Analysis ◽  
Clinical Decision ◽  
User Friendliness ◽  
Point Of Care Test ◽  
Percentage Difference ◽  
Difference Plot

AimsN-terminal pro-B-type natriuretic peptide (NT-proBNP) has been shown to be useful for ruling out heart failure in primary care. In this study, we examined the accuracy of the Cobas h232 point-of-care (POC) instrument in primary care compared with an in-hospital measurement. Furthermore, we investigated the user-friendliness and usefulness of the POC device.MethodsFive general practitioner (GP) groups were asked to evaluate adult patients who were suspected of having heart failure and to test NT-proBNP with the Cobas h232. The samples were subsequently delivered to and analysed at a central hospital laboratory by the Cobas e602 using conventional transport and storage. Difference between the paired measurements was analysed using a percentage difference plot, and correlation was assessed using Passing-Bablok linear regression analysis. User-friendliness and usefulness were assessed using semistructured questionnaires.ResultsNineteen GPs studied 94 patients. Passing-Bablok analysis showed a slope of 1.05 (95% CI 1.00 to 1.11) (R2=0.97). The percentage difference plot showed a mean difference of 15.7% (95% CI −46.0% to –77.4%). User-friendliness and usefulness had median scores of 4 or 5 on a five-point Likert scale. Eighteen out of 19 GPs confirmed that the device influenced their clinical practice. During the study, GPs’ confidence in using NT-proBNP increased significantly from a mean score of 4.4 (95% CI 3.2 to 5.6) to 7.6 out of 10 (95% CI 7.1 to 8.2).ConclusionsThe Cobas h232 NT-proBNP POC test proved to be an accurate, user-friendly and useful test in primary care. Nearly all participating GPs were convinced that the test could benefit clinical decision making.

Routes to diagnosis of heart failure: observational study using linked data in England

Heart ◽  
2017 ◽  
Vol 104 (7) ◽  
pp. 600-605 ◽  
Author(s):  
Alex Bottle ◽  
Dani Kim ◽  
Paul Aylin ◽  
Martin R Cowie ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Natriuretic Peptide ◽  
Hospital Admissions ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Missed Opportunities ◽  
Specialist Referral ◽  
Care Consultation ◽  
Primary Care Practices

ObjectiveTimely diagnosis and management of heart failure (HF) is critical, but identification of patients with suspected HF can be challenging, especially in primary care. We describe the journey of people with HF in primary care from presentation through to diagnosis and initial management.MethodsWe used the Clinical Practice Research Datalink (primary care consultations linked to hospital admissions data and national death registrations for patients registered with participating primary care practices in England) to describe investigation and referral pathways followed by patients from first presentation with relevant symptoms to HF diagnosis, particularly alignment with recommendations of the National Institute for Health and Care Excellence guideline for HF diagnosis.Results36 748 patients had a diagnosis of HF recorded that met the inclusion criteria between 1 January 2010 and 31 March 2013. For 29 113 (79.2%) patients, this was first recorded in hospital. In the 5 years prior to diagnosis, 15 057 patients (41.0%) had a primary care consultation with one of three key HF symptoms recorded, 17 724 (48.2%) attended for another reason and 3967 (10.8%) did not see their general practitioner. Only 24% of those with recorded HF symptoms followed a pathway aligned with guidelines (echocardiogram and/or serum natriuretic peptide test and specialist referral), while 44% had no echocardiogram, natriuretic peptide test or referral.ConclusionsPatients follow various pathways to the diagnosis of HF. However, few appear to follow a pathway supported by guidelines for investigation and referral. There are likely to be missed opportunities for earlier HF diagnosis in primary care.

Chronic heart failure diagnosis: biomarkers

ESC CardioMed ◽  
2018 ◽  
pp. 1778-1781
Author(s):  
Christian Mueller
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Point Of Care ◽  
Failure Diagnosis ◽  
Central Laboratory ◽  
Important Advance ◽  
Cardiac Stress ◽  
Heart Failure Diagnosis

Natriuretic peptides including B-type natriuretic peptide (BNP), N-terminal (NT)-proBNP, and midregional pro-atrial natriuretic peptide (MR-proANP) are the biomarkers of choice in the diagnosis of heart failure. Assays measuring either BNP, NT-proBNP, or MR-proANP are widely available and run on large analysers operating in the central laboratory or as point-of-care options. Natriuretic peptides are considered quantitative markers of haemodynamic cardiac stress and therefore quantitative markers of heart failure itself. The clinical introduction of natriuretic peptides constitutes the most important advance in the diagnosis of heart failure in the last decade.

Chronic heart failure diagnosis: biomarkers

ESC CardioMed ◽  
2018 ◽  
pp. 1778-1781
Author(s):  
Christian Mueller
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Point Of Care ◽  
Failure Diagnosis ◽  
Central Laboratory ◽  
Important Advance ◽  
Cardiac Stress ◽  
Heart Failure Diagnosis

Natriuretic peptides including B-type natriuretic peptide (BNP), N-terminal (NT)-proBNP, and midregional pro-atrial natriuretic peptide (MR-proANP) are the biomarkers of choice in the diagnosis of heart failure. Assays measuring either BNP, NT-proBNP, or MR-proANP are widely available and run on large analysers operating in the central laboratory or as point-of-care options. Natriuretic peptides are considered quantitative markers of haemodynamic cardiac stress and therefore quantitative markers of heart failure itself. The clinical introduction of natriuretic peptides constitutes the most important advance in the diagnosis of heart failure in the last decade.

Chronic heart failure diagnosis: biomarkers

ESC CardioMed ◽  
2018 ◽  
pp. 1778-1781
Author(s):  
Christian Mueller
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Point Of Care ◽  
Failure Diagnosis ◽  
Central Laboratory ◽  
Important Advance ◽  
Cardiac Stress ◽  
Heart Failure Diagnosis

Natriuretic peptides including B-type natriuretic peptide (BNP), N-terminal (NT)-proBNP, and midregional pro-atrial natriuretic peptide (MR-proANP) are the biomarkers of choice in the diagnosis of heart failure. Assays measuring either BNP, NT-proBNP, or MR-proANP are widely available and run on large analysers operating in the central laboratory or as point-of-care options. Natriuretic peptides are considered quantitative markers of haemodynamic cardiac stress and therefore quantitative markers of heart failure itself. The clinical introduction of natriuretic peptides constitutes the most important advance in the diagnosis of heart failure in the last decade.

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