Action on elevated natriuretic peptide in primary care: a retrospective cohort study.

IF 2.5 Q2 PRIMARY HEALTH CARE BJGP Open Pub Date : 2024-09-04 DOI:10.3399/BJGPO.2024.0017
Cornelia Jc Vermeer, Monika Hollander, Anne Jm Stolk, Amy Groenewegen, G J Geersing, Frans H Rutten, Huberta E Hart
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Abstract

Background: Natriuretic peptides (NPs) are released by increased ventricular wall stress, most often caused by heart failure (HF). NP level measurement helps select patients clinically suspected of HF who need echocardiography. Yet, the diagnostic actions following NP testing in daily primary care are poorly studied.

Aim: To assess the diagnostic actions taken by general practitioners (GPs) in patients with an elevated NP level.

Design & setting: Retrospective observational study in general practices in the Netherlands.

Method: In patients with an elevated NP level between July 2017 and July 2022 diagnostic actions were gathered during three months following NP testing. We compared patients with an elevated NP level referred for echocardiography to those not referred by univariable analyses.

Results: Among 902 patients, 394 (43.7%) had an elevated NP level. Median age was 75.0 (IQR 18.0) years, 68.8% were female. In total, 166 (42.1%) were referred for echocardiography and 114 (28.9%) underwent additional ECG recording. 30/166 (18.1%) referred patients were labelled HF by the cardiologist within three months after NP testing compared to 29/228 (12.7%) not referred. Referred patients were compared to those not referred younger (69.7 vs. 74.1 years, P<.001), less already known to a cardiologist (46.3% vs. 62.3%, P=.002), and had less marginally increased BNP levels (35-50 pg/mL) (19.9% vs. 37.5%, P<.001).

Conclusions: Three out of five patients with an elevated NP level are not referred for echocardiography by GPs. Restraint to refer patients were older age, a marginally elevated BNP value, and already being under control of a cardiologist.

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对基层医疗机构中升高的钠尿肽采取行动:一项回顾性队列研究。
背景:钠尿肽(NPs)会在心室壁应力增加时释放,而心室壁应力增加多由心力衰竭(HF)引起。NP水平的测量有助于选择临床上怀疑患有心力衰竭并需要进行超声心动图检查的患者。目的:评估全科医生(GPs)对 NP 水平升高的患者采取的诊断措施:荷兰全科医生的回顾性观察研究:对2017年7月至2022年7月期间NP水平升高的患者在NP检测后三个月内采取的诊断措施进行收集。我们通过单变量分析比较了转诊接受超声心动图检查和未转诊的 NP 水平升高患者:902名患者中,394人(43.7%)NP水平升高。中位年龄为 75.0(IQR 18.0)岁,68.8% 为女性。共有 166 人(42.1%)被转诊接受超声心动图检查,114 人(28.9%)接受了额外的心电图记录。30/166(18.1%)名转诊患者在接受 NP 检查后三个月内被心脏病专家确诊为 HF,而 29/228 (12.7%)名未转诊患者则被确诊为 HF。与未转诊患者相比,转诊患者的年龄更小(69.7 岁对 74.1 岁,PP=.002),BNP 水平(35-50 pg/mL)轻微升高的患者更少(19.9% 对 37.5%,PConclusions.PP=.002):五分之三的 NP 水平升高患者未被全科医生转诊进行超声心动图检查。转诊患者的限制因素包括年龄较大、BNP 值略有升高以及已在心脏病专家的控制之下。
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来源期刊
BJGP Open
BJGP Open Medicine-Family Practice
CiteScore
5.00
自引率
0.00%
发文量
181
审稿时长
22 weeks
期刊最新文献
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