Teleanu Ioana Camelia, Mîrșu-Păun Anca, Bejan Cristian Gabriel, Stănescu Ana-Maria Alexandra
Department of Family Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania.
Epidemiologia (Basel). 2025 Jan 15;6(1):2. doi: 10.3390/epidemiologia6010002.
Epidemiological studies indicate that heart failure (HF) prevalence and associated mortality are significantly higher among Eastern European countries as compared to their Western European counterparts. The significant financial burden on the healthcare system matches these sobering data. Thus, efficient programs for patients with HF have been called for. N-terminal prohormone of brain natriuretic peptide (NT-proBNP) represents a widely used, cost-effective, and readily available test that can be used to evaluate HF risk. However, it should not be used as a universal assessment, given the existing variability in proposed cut-off scores for various subgroups of patients. Thus, the clinical context needs to always be considered, and alternative diagnoses need to be ruled out. Based upon evidence from the literature for the above assumptions, the advantages and limitations of using NT-proBNP in primary care settings, along with other HF diagnostic modalities, are discussed in this paper. Also, this paper argues that an effective primary care network, in collaboration with specialist providers, may avoid a delay in HF diagnoses, may help provide on-time treatments, and may ultimately cut unnecessary healthcare expenditures associated with HF hospitalizations. Therefore, the present paper proposes an algorithm for diagnosing HF in primary care settings and discusses specific knowledge and skills that family physicians should be well equipped with in order to successfully respond to the needs of their patients with HF.
流行病学研究表明，与西欧国家相比，东欧国家的心力衰竭（HF）患病率及相关死亡率显著更高。医疗系统面临的巨大经济负担与这些严峻的数据相符。因此，人们呼吁为心力衰竭患者制定有效的方案。脑钠肽前体N端（NT-proBNP）是一种广泛应用、经济高效且易于获取的检测指标，可用于评估心力衰竭风险。然而，鉴于针对不同患者亚组提出的临界值存在差异，不应将其用作通用评估方法。因此，始终需要考虑临床背景，并排除其他诊断。基于上述假设的文献证据，本文讨论了在基层医疗环境中使用NT-proBNP以及其他心力衰竭诊断方法的优缺点。此外，本文认为，有效的基层医疗网络与专科医疗服务提供者合作，可避免心力衰竭诊断延误，有助于及时提供治疗，并最终减少与心力衰竭住院相关的不必要医疗支出。因此，本文提出了一种在基层医疗环境中诊断心力衰竭的算法，并讨论了家庭医生为成功满足心力衰竭患者需求应具备的特定知识和技能。
