Utility of NT-proBNP as a rule-out test for left ventricular dysfunction in very old people with limiting dyspnoea: the Newcastle 85+ Study

Collerton, Joanna; Kingston, Andrew; Yousaf, Fahad; Davies, Karen; Kenny, Antoinette; Neely, Dermot; Martin-Ruiz, Carmen; MacGowan, Guy A.; Robinson, Louise; Kirkwood, Thomas B. L.; Keavney, Bernard

doi:10.1186/1471-2261-14-128

Cited by 8 publications

(10 citation statements)

References 33 publications

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“…This is in agreement with a previous data reporting the predictive value of NT pro‐BNP for long‐ and short‐term mortality in older patients with CV diseases . However, the use of NT pro‐BNP in older patients has been discussed controversially, due to the correlation between natriuretic peptide plasma concentration, gender and age . In contrast, the present study shows the independent predictive value of elevated NT pro‐BNP plasma concentration for mortality, regardless of gender and age.…”

Section: Discussionsupporting

confidence: 93%

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ADMA and NT pro‐BNP are associated with overall mortality in elderly

Rezaei

Weisshaar

Litschauer

et al. 2018

Eur J Clin Investigation

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Background Increased asymmetrical dimethylarginine ( ADMA ) and NT pro‐ BNP concentrations have been associated with mortality in patients with cardiovascular ( CV ) disease and the general population. The use of these prognostic markers in an older population is not established yet. The aim of the present study was to investigate the prognostic value of age, sex, BMI , co‐medication and CV laboratory risk markers in geriatric care patients. Materials and methods In this prospective observational single‐centre cohort study data of long‐term geriatric care patients were collected. Blood samples were collected between 14.09.2009 and 16.12.2009, and mortality was recorded up to 90 months. ADMA , its symmetric isomer SDMA , L‐arginine, NT pro‐ BNP and CRP were determined at study entry. Simple associations of risk factors for survival period were explored by Spearman correlation coefficient. Significant univariate predictors for survival period were used in the Cox proportional hazard model. Results A total of 481 patients were screened, and data from 449 patients were analysed. A total of 381 patients died during the observation period. Full data sets from 344 patients were used for Cox regression analysis. Male sex, older age, lower BMI , use of neuroleptic medicine, peripheral artery disease, and elevated plasma concentrations of ADMA , NT pro‐ BNP , and CRP were significant predictors of mortality. Conclusion The concentration of ADMA and NT pro‐ BNP may be used as an early risk marker for overall mortality in geriatric care. Neuroleptic medicine is associated with increased mortality in this population.

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Section: Discussionsupporting

confidence: 93%

“…23 However, the use of NT pro-BNP in older patients has been discussed controversially, due to the correlation between natriuretic peptide plasma concentration, gender and age. 24,25 In contrast, the present study shows the independent predictive value of elevated NT pro-BNP plasma concentration for mortality, regardless of gender and age.…”

Section: Discussioncontrasting

confidence: 88%

ADMA and NT pro‐BNP are associated with overall mortality in elderly

Rezaei

Weisshaar

Litschauer

et al. 2018

Eur J Clin Investigation

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“…There is an increasing number of patients with HF who could benefit from ameliorated therapy strategies. However, in practice, if the decision limits are applied for older patients with higher NP concentrations, several false-positive results and unnecessary follow-up diagnostics may be generated, as shown in the Newcastle 85+ study (13) and in a large Dutch primary care study (14). In general, laboratory reports should clearly distinguish between reference values and decision limits for HF to avoid confusing clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…Heart failure (HF) 13 is a major cause of morbidity, mortality, and decreased quality of life (1). The HF pilot study [European Society of Cardiology (ESC)-HF pilot] reported a poor medium-term prognosis with a cumulative all-cause 1-year mortality of 17.4% in patients with acute HF (2).…”

mentioning

confidence: 99%

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

Hammerer-Lercher

Collinson

Suvisaari

et al. 2017

The Journal of Applied Laboratory Medicine

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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.

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“… 6 This algorithm has not proven more beneficial than algorithms using only natriuretic peptides. 12 13 Two new diagnostic algorithms have been published 7 8 including an algorithm specifically designed for elderly patients. 8 However, the ability of these algorithms to identify non-acute heart failure in symptomatic patients aged 80 years and older has never been compared.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic rules and algorithms for the diagnosis of non-acute heart failure in patients 80 years of age and older: a diagnostic accuracy and validation study

et al. 2016

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ObjectivesDifferent diagnostic algorithms for non-acute heart failure (HF) exist. Our aim was to compare the ability of these algorithms to identify HF in symptomatic patients aged 80 years and older and identify those patients at highest risk for mortality.DesignDiagnostic accuracy and validation study.SettingGeneral practice, Belgium.Participants365 patients with HF symptoms aged 80 years and older (BELFRAIL cohort). Participants underwent a full clinical assessment, including a detailed echocardiographic examination at home.Outcome measuresThe diagnostic accuracy of 4 different algorithms was compared using an intention-to-diagnose analysis. The European Society of Cardiology (ESC) definition of HF was used as the reference standard for HF diagnosis. Kaplan-Meier curves for 5-year all-cause mortality were plotted and HRs and corresponding 95% CIs were calculated to compare the mortality risk predicting abilities of the different algorithms. Net reclassification improvement (NRI) was calculated.ResultsThe prevalence of HF was 20% (n=74). The 2012 ESC algorithm yielded the highest sensitivity (92%, 95% CI 83% to 97%) as well as the highest referral rate (71%, n=259), whereas the Oudejans algorithm yielded the highest specificity (73%, 95% CI 68% to 78%) and the lowest referral rate (36%, n=133). These differences could be ascribed to differences in N-terminal probrain natriuretic peptide cut-off values (125 vs 400 pg/mL). The Kelder and Oudejans algorithms exhibited NRIs of 12% (95% CI 0.7% to 22%, p=0.04) and 22% (95% CI 9% to 32%, p<0.001), respectively, compared with the ESC algorithm. All algorithms detected patients at high risk for mortality (HR 1.9, 95% CI 1.4 to 2.5; Kelder) to 2.3 (95% CI 1.7 to 3.1; Oudejans). No significant differences were observed among the algorithms with respect to mortality risk predicting abilities.ConclusionsChoosing a diagnostic algorithm for non-acute HF in elderly patients represents a trade-off between sensitivity and specificity, mainly depending on differences between cut-off values for natriuretic peptides.

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Utility of NT-proBNP as a rule-out test for left ventricular dysfunction in very old people with limiting dyspnoea: the Newcastle 85+ Study

Cited by 8 publications

References 33 publications

ADMA and NT pro‐BNP are associated with overall mortality in elderly

ADMA and NT pro‐BNP are associated with overall mortality in elderly

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

Diagnostic rules and algorithms for the diagnosis of non-acute heart failure in patients 80 years of age and older: a diagnostic accuracy and validation study

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