a Department of Clinical Biochemistry, Randers Regional Hospital , Randers , Denmark.
b Department of Public Health, Section of General Medical Practice, Aarhus University , Aarhus , Denmark.
Scand J Clin Lab Invest. 2019 Sep;79(5):334-340. doi: 10.1080/00365513.2019.1622034. Epub 2019 May 29.
Heart failure (HF) is difficult to recognize in primary care. N-terminal pro B-type natriuretic peptide (NT-proBNP) can be used as a rule-out test in HF due to its high negative predictive value. We aim to determine whether the number per 1000 patients of HF diagnoses increase among patients referred from primary care to an outpatient HF clinic, if general practitioners (GPs) were offered NT-proBNP in a real-life setting. All GP practices covered by Randers Regional Hospital were randomized to an intervention group (34 GP practices) and a control group (35 GP practices) in this pragmatic, cluster-randomized controlled trial. The main outcome was the number of patients referred to echocardiography and diagnosed with HF in each group. The number of patients per 1000 diagnosed with HF in the two groups was the same (0.09 (0.02-0.16) vs. 0.14 (0.07-0.21), = .3541). A total of 700 NT-proBNP analyses, of which 611 were unique, were requested from 31 GP practices in 17.5 months. A total of 184 patients were referred to echocardiography on suspicion of HF. The number of patients per 1000 referred in the intervention group was significantly higher ( < .010). NT-proBNP was measured in 36.6% of referred patients in the intervention group. Significantly more women were diagnosed with HF in the intervention group (56.3% vs. 0%, = .019). Hence, increased diagnostic effectiveness could not be shown in this real-life setting.
心力衰竭（HF）在初级保健中难以识别。由于其高阴性预测值，N 末端脑利钠肽前体（NT-proBNP）可用作 HF 的排除性检查。我们旨在确定在向门诊 HF 诊所转介的患者中，如果为全科医生（GP）提供 NT-proBNP，是否会增加每 1000 例患者中 HF 诊断的数量。在这项实用的、整群随机对照试验中，兰德斯地区医院覆盖的所有全科医生诊所被随机分为干预组（34 个全科医生诊所）和对照组（35 个全科医生诊所）。主要结局是每个组中转诊行超声心动图检查和诊断为 HF 的患者数量。两组中每 1000 例患者中诊断为 HF 的患者数量相同（0.09（0.02-0.16）与 0.14（0.07-0.21）， = .3541）。在 17.5 个月内，从 31 个全科医生诊所中要求进行了 700 次 NT-proBNP 分析，其中 611 次是唯一的。共有 184 名患者因怀疑 HF 而被转诊行超声心动图检查。干预组中每 1000 例转诊的患者数量明显更高（ < .010）。在干预组中，有 36.6%的转诊患者进行了 NT-proBNP 测量。在干预组中，诊断为 HF 的女性明显更多（56.3%与 0%， = .019）。因此，在这种现实环境中无法显示出诊断效果的提高。
