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1
The Introduction of a new service for NTproBNP
for primary care physicians C J Seneviratne1,
Gill Burrows1, T Emery3 P S Lewis2, F
Poisson2, 1Clinical Biochemistry and 2Cardiology
at Stockport NHS Foundation Trust, and 3Stockport
PCT
Request form for NTproBNP and Echocardiography if
indicated (form is mandatory if test is to be
performed)
Introduction Measurement of serum NTproBNP
(B-type naturetic peptide) can be used to exclude
heart failure. A service was developed using this
test as a gateway to echocardiography. A
positive test causes a referral for
echocardography a negative test prompts
investigations for an alternative diagnosis. This
service was introduced, and funded, within
Stockport PCT, for use by GPs only, in January
2005, with a care pathway and special request
form. A patient information leaflet was also
prepared.
Care Pathway for Patients with suspected Heart
Failure
Results To September 2006, 646 valid requests
were made from 52 different practices. There was
a variable take up by practices (fig 1), with
median number of tests per practice of 7. The age
distribution of the patients is shown in fig 2
Fig 2
Fig 1

• Reporting the results
• Action values were age and sex related and
  results were reported with an appropriate comment
  
• 125ng/L for males under the age of 70.
• 150ng/L for females under the age of 70.
• 300ng/L for males and females aged 70 and over.
• If result below cut-off value, comment
• Likelihood of left ventricular systolic
  dysfunction lt5. Suggest investigate for other
  causes of breathlessness
• If result above cut-off value
• NTpBNP is elevated, which may indicate LV
  dysfunction. Appointment for echocardiogram will
  be arranged.
• If the result is elevated the request is
  forwarded to Cardiology who contact the patient
  to make an appointment for Echocardiography

• Of these requests
• 375 had negative results
• 271 had positive results
• 258 had echocardiography

Conclusion A new and relatively expensive test
can be introduced in a cost effective way though
use of a care pathway with clear requesting
guidance and where follow-up is determined by the
test outcome. GPs will now be allowed to request
the test on normal forms and use will be audited.