Are Heart Failure Management Recommendations and Guidelines Followed in Laboratory Medicine in Europe and North America? The Cardiac Marker Guideline Uptake in Europe (CARMAGUE) Study

Abstract

Background: The aim of this survey was to investigate how well heart failure (HF) guidelines for use of natriuretic peptides (NPs) have been implemented in laboratory practice in Europe and North America. Methods: In 2013 and 2014, a web-based questionnaire was distributed via North American and European biochemical societies. Questions covered assay performed, reason for method choice, decision limits for HF, and laboratory accreditation status. Results: There were 442 European Union and 91 North American participating laboratories with response rates of 50% and 64% from major or university hospitals, respectively. NP measurements were offered in 67% of European Union and 58% of North American respondents. N-terminal pro-B-type natriuretic peptide (NT-proBNP) was most widely used in Europe (68%) and B-type natriuretic peptide (BNP) was more commonly used (58%) in North America. The most frequent reason for use of a specific assay was the availability of instruments that measure either NT-proBNP (51%) or BNP (67%). For diagnosis of acute HF, NT-proBNP decision limits were diverse; age-dependent limits based on the 2012 European Society of Cardiology (ESC) recommendations were used in only 17% of European sites and 26% of North American sites. For BNP, the guideline-recommended acute HF decision limit of 100 ng/L was better adhered to in Europe (48%) and North America (57%). Surprisingly, similar decision limits were stated for acute and chronic HF by >50% of respondents. Conclusions: NP measurement for HF diagnosis was available in >50% of responding laboratories. However, guideline recommended cutoff values for both acute and chronic HF were still implemented in <30% of participating medical centers. IMPACT STATEMENT This study investigated the fidelity of European Union and North American laboratory adherence to heart failure guidelines. In 2013 and 2014, a web-based questionnaire was distributed via North American and European professional laboratory societies. These survey results highlight that guideline recommended cutoff values have not been implemented adequately in practice, which likely leads to discrepancies in diagnosis and treatment of heart failure.

Biochemical or clinical heart failure, not so simple

“…However, this unsolved pathophysiological issue has hampered a wide acceptance of NPs and their incorporation into clinical and laboratory settings. Indeed, NPs were not definitely included into the diagnostic algorithms until the 2012 guidelines, 8 and subsequent surveys showed a predominantly restricted use by clinicians 9,10 …”

“…Indeed, NPs were not definitely included into the diagnostic algorithms until the 2012 guidelines, 8 and subsequent surveys showed a predominantly restricted use by clinicians. 9,10 The study by Caro-Codón et al 1 describes the clinical practice regarding the use of NT-proBNP in patients with dyspnoea who attended the emergency room of a tertiary hospital in 2020, during the first wave of the coronavirus disease 2019 (COVID-19) pandemic in Europe. The first comment is that physicians in charge measured NT-proBNP in less than 13% (n = 396) of all admitted patients.…”

Health economic evaluations of medical tests: Translating laboratory information into value – A case study example

“…18 As a result, point estimates can be replaced by a more statistical expression of model outputs. Since reports indicate that the use of medical tests can deviate substantially from recommended guidelines, and that test ordering can be influenced by several non-medical factors, [30][31] assumptions about clinical decisions particularly for a new test should be scrutinized carefully.…”

Natriuretic Peptide Testing Guidelines: A Need for Harmony Among the Cacophony

“…In this issue of JALM, Hammerer-Lercher et al (1) published the results of the Cardiac Marker Guideline Uptake in Europe (CARMAGUE) 2 survey of European and North American laboratory use of natriuretic peptide (NP) assays. These survey results were acquired in 2013/2014 and provide insight into the surprisingly modest uptake of NP assays across both continents.…”