Mak G, Ryder M, Murphy N F, O'Loughlin C, McCaffrey D, Ledwidge M, McDonald K
Heart Failure Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, UK.
Ir J Med Sci. 2008 Sep;177(3):197-203. doi: 10.1007/s11845-008-0186-3. Epub 2008 Jul 17.
Brain natriuretic peptide (BNP) may help general practitioners (GPs) to "rule-out" heart failure (HF) and reduce referral burden on specialist assessment clinics.
To determine the diagnostic value of BNP in HF referrals by GPs to a specialist unit.
From 2003 to 2007, 327 GP referrals were made to a HF new patient diagnostic clinic (NDC) with a provisional diagnosis of HF. The NDC provides rapid assessment of potential HF patients and ensures appropriate therapy and follow-up for those with a confirmed diagnosis. HF diagnosis was confirmed by the Framingham criteria.
HF was present in 39% of cases referred (mean age 75 +/- 10 years, 49% male). The inclusion of BNP as a "rule-out" test with a cut-off value of 100 pg/mL would have reduced the number of patients originally referred to the NDC by 175. However, this would have resulted in delayed diagnosis and treatment of 20 (16%) "false-negative" patients.
Availability of BNP to GPs would improve referral patterns but with high risk of delayed diagnosis. The data underline the need for a shared-care approach to the new diagnosis of HF.
脑钠肽（BNP）可能有助于全科医生“排除”心力衰竭（HF），并减轻专科评估诊所的转诊负担。
确定BNP在全科医生转诊至专科单位的HF患者中的诊断价值。
2003年至2007年，327例被全科医生转诊至HF新患者诊断诊所（NDC）的患者被初步诊断为HF。NDC对潜在的HF患者进行快速评估，并确保对确诊患者进行适当的治疗和随访。HF诊断通过弗明翰标准确认。
在转诊的病例中，39%存在HF（平均年龄75±10岁，49%为男性）。将BNP作为“排除”试验，临界值设定为100 pg/mL，原本转诊至NDC的患者数量将减少175例。然而，这将导致20例（16%）“假阴性”患者的诊断和治疗延迟。
全科医生可获得BNP将改善转诊模式，但存在诊断延迟的高风险。这些数据强调了对HF新诊断采用共享照护方法的必要性。
