Affiliation:
1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford OX2 6GG, UK
Abstract
Abstract
Aims
Heart failure (HF) is a malignant condition with poor outcomes and is often diagnosed on emergency hospital admission. Natriuretic peptide (NP) testing in primary care is recommended in international guidelines to facilitate timely diagnosis. We aimed to report contemporary trends in NP testing and subsequent HF diagnosis rates over time.
Methods and results
Cohort study using linked primary and secondary care data of adult (≥45 years) patients in England 2004–18 (n = 7 212 013, 48% male) to report trends in NP testing (over time, by age, sex, ethnicity, and socioeconomic status) and HF diagnosis rates. NP test rates increased from 0.25 per 1000 person-years [95% confidence interval (CI) 0.23–0.26] in 2004 to 16.88 per 1000 person-years (95% CI 16.73–17.03) in 2018, with a significant upward trend in 2010 following publication of national HF guidance. Women and different ethnic groups had similar test rates, and there was more NP testing in older and more socially deprived groups as expected. The HF detection rate was constant over the study period (around 10%) and the proportion of patients without NP testing prior to diagnosis remained high [99.6% (n = 13 484) in 2004 vs. 76.7% (n = 12 978) in 2017].
Conclusion
NP testing in primary care has increased over time, with no evidence of significant inequalities, but most patients with HF still do not have an NP test recorded prior to diagnosis. More NP testing in primary care may be needed to prevent hospitalization and facilitate HF diagnosis at an earlier, more treatable stage.
Funder
NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford
NIHR Oxford Biomedical Research Centre (BRC) and NIHR Applied Research Collaborative (ARC) Oxford and Thames Valley
NIHR School for Primary Care Research
NIHR ARC Oxford and Thames Valley
NIHR Oxford BRC
Wellcome Trust Fellowship
NJ is a Wellcome Trust Doctoral Research Fellow
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine
Cited by
12 articles.
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