B‐type natriuretic peptide in the evaluation and management of dyspnoea in primary care

Burri, Emanuel; Hochholzer, Kirsten; Arenja, Nisha; Martin-Braschler, H.; Kaestner, Lars; Gekeler, H.; Hatziisaak, T.; Büttiker, M.; Fräulin, A.; Potocki, Mihael; Breidthardt, Tobias; Reichlin, Tobias; Socrates, Thenral; Twerenbold, Raphael; Müeller, Christian

doi:10.1111/j.1365-2796.2012.02552.x

Cited by 26 publications

(21 citation statements)

References 39 publications

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“…The three papers 265,288,289 examining other (non-spirometry) technologies suggested that POC testing can have a positive impact on GP differential diagnosis, diagnostic certainty and time to treatment, although the impact on specialist referral is less clear. A simple algorithm for asthma also may be a useful decision-aid.…”

Section: Summary Of Evidence From Intervention Studiesmentioning

confidence: 99%

“…All but three 265,284,288 of these examined the use of spirometry by primary care staff. The papers considered the potential value of spirometry during a consultation, the accuracy of spirometry carried out in primary care, and whether or not training courses could enhance the quality of spirometry.…”

Section: Additional Diagnostic Technology/information In the General mentioning

confidence: 99%

“…The papers considered the potential value of spirometry during a consultation, the accuracy of spirometry carried out in primary care, and whether or not training courses could enhance the quality of spirometry. Five of the studies 261,264,265,279,284 used controlled designs.…”

Section: Additional Diagnostic Technology/information In the General mentioning

confidence: 99%

“…265,288,289 One study evaluated the provision of BNP testing in primary care 265 and one examined results following the use of a POC testing analyser in GP practices. 288 The final study in this group reported the development and testing of an algorithm which GPs could use to support a diagnosis of asthma.…”

Section: Harris Et Almentioning

confidence: 99%

“…288 The final study in this group reported the development and testing of an algorithm which GPs could use to support a diagnosis of asthma. 289 Burri et al 265 carried out a RCT in Switzerland to evaluate whether or not adding BNP testing in primary care would improve the evaluation and diagnosis of patients with breathlessness. The study found that use…”

Section: Harris Et Almentioning

confidence: 99%

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Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Chambers

Baxter

Johnson

et al. 2016

Health Serv Deliv Res

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BackgroundCurrent NHS policy favours the expansion of diagnostic testing services in community and primary care settings.ObjectivesOur objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community.Review methodsWe performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion.ResultsWe identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed.ConclusionsIn the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control.LimitationsWe have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers.Future workThere is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Summary Of Evidence From Intervention Studiesmentioning

confidence: 99%

Section: Additional Diagnostic Technology/information In the General mentioning

confidence: 99%

Section: Additional Diagnostic Technology/information In the General mentioning

confidence: 99%

Section: Harris Et Almentioning

confidence: 99%

Section: Harris Et Almentioning

confidence: 99%

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Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Chambers

Baxter

Johnson

et al. 2016

Health Serv Deliv Res

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Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations

Müeller

McDonald

Boer

et al. 2019

European J of Heart Fail

536

473

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Natriuretic peptide [NP; B-type NP (BNP), N-terminal proBNP (NT-proBNP), and midregional proANP (MR-proANP)] concentrations are quantitative plasma biomarkers for the presence and severity of haemodynamic cardiac stress and heart failure (HF). End-diastolic wall stress, intracardiac filling pressures, and intracardiac volumes seem to be the dominant triggers. This paper details the most important indications for NPs and highlights 11 key principles underlying their clinical use shown below.(i) NPs should always be used in conjunction with all other clinical information.(ii) NPs are reasonable surrogates for intracardiac volumes and filling pressures. (iii) NPs should be measured in all patients presenting with symptoms suggestive of HF such as dyspnoea and/or fatigue, as their use facilitates the early diagnosis and risk stratification of HF. (iv) NPs have very high diagnostic accuracy in discriminating HF from other causes of dyspnoea: the higher the NP, the higher the likelihood that dyspnoea is caused by HF. (v) Optimal NP cut-off concentrations for the diagnosis of acute HF (very high filling pressures) in patients presenting to the emergency department with acute dyspnoea are higher compared with those used in the diagnosis of chronic HF in patients with dyspnoea on exertion (mild increase in filling pressures at rest). (vi) Obese patients have lower NP concentrations, mandating the use of lower cut-off concentrations (about 50% lower). (vii) In stable HF patients, but also in patients with other cardiac disorders such as myocardial infarction, valvular heart disease, atrial fibrillation or pulmonary embolism, NP concentrations have high prognostic accuracy for death and HF hospitalization.

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Biomarkers of Cardiovascular Disorders

Jain¹

2017

The Handbook of Biomarkers

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B‐type natriuretic peptide in the evaluation and management of dyspnoea in primary care

Cited by 26 publications

References 39 publications

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations

Biomarkers of Cardiovascular Disorders

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