THE IMPACT OF INTRODUCING AN NTproBNP SERVICE INTO CLINICAL PRACTICE

1
THE IMPACT OF INTRODUCING AN NT-proBNP SERVICE
INTO CLINICAL PRACTICE
S Knowles, S Burn, M Cassidy, P Wood, J Mayne, D
Docherty, J S Harrop
Depts of Chemical Pathology and Cardiology,
Derbyshire Royal Infirmary, Derby, and Erewash
Primary Care Trust
E-mail john.harrop_at_derbyhospitals.nhs.uk
Introduction Serum B-type natriuretic peptide and
N-terminal proBNP (NT-proBNP)1 are promising new
markers for the diagnosis, prognosis, and
treatment of heart failure. Accompanied by
appropriate publicity, we started an NT-proBNP
service for primary care in October 2004, and we
present here some preliminary data concerning a)
the uptake of this new test by our GPs, and b)
changes in patient management associated with
this new test. PCT funding was made available
for 3,300 tests / year. Our served population
is 560,000.
GP Questionnaire A simple questionnaire was sent
out with each NT-proBNP report. This asked for
basic clinical data, medication, and management
with and without the NT-proBNP result. The
return rate was 84.
Patients
Symptoms and NT-proBNP requesting
Uptake of NT-proBNP test in Primary Care
Funded service
Signs and NT-proBNP requesting
Effects of testing on patient management
Funded service

• COMMENTS
• After just 6 months, demand from primary care is
  matching available funding.
• Some practices are exceeding funded use of the
  test per 1000 patients, even when this is
  estimated using limited initial data.
• Almost all practices are now using the NT
  pro-BNP service.

reduction 60 44
76 38

• COMMENTS
• Dyspnoea, fatigue and oedema are the commonest
  symptoms associated with an NT-proBNP request.
• Oedema and chest crackles are the commonest
  recorded signs.
• There is a noticeable reduction in patient
  referrals for open-access echocardiography, and
  for other hospital services.

ACTION LIMITS and reporting NT-proBNP
results We report an age and sex-related
ref.range (Roche data) but use one action limit
of 36 pmol/L1. We advise that values below this,
in untreated patients, make heart failure very
unlikely higher values require further
investigation. Serum creatinine is also measured,
and provisos added when creatinine gt200 umol/L.

• Conclusions
• There is demand for measurement of natriuretic
  peptides in primary care, with major resource
  implications.
• Changes in patient management are significant,
  with possible off-setting resource implications.
• Anecdotal comment from GPs indicate that
  NT-proBNP is a useful investigation it is
  regarded as a good test !

Results to date up to 36
gt36 pmol/L FEMALES 42 - of whom 55
45 (38-4130) MALES 58 - of whom
50 50 (38-4139)
1. Hobbs et al. BMJ 2002 324 1489-1500