A blood test (BNP) should be recommended over an electrocardiogram (ECG) for the diagnosis of heart failure suggests research published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme.

Heart failure is associated with significant morbidity, mortality, and healthcare expenditure. There is however, a good evidence base for interventions to improve prognosis although the diagnosis of heart failure in primary care is often inaccurate. Current NICE recommendations are that patients in whom heart failure is suspected should undergo ECG and/or BNP. If either of these is positive, they should then be referred for echocardiography as part of their diagnostic work-up.

The study led by Professor Jonathan Mant, University of Cambridge, reviewed existing evidence to determine the best way for primary care physicians to diagnose heart failure in the UK.

From their findings the research team have developed a simple clinical rule: patients who present with symptoms such as breathlessness and in whom heart failure is suspected should be referred directly to echocardiography if they have: a history of MI, basal crepitations, or are male and have ankle oedema. Otherwise a BNP test should be conducted initially, and depending on these results, then referred for echocardiography.

"From our research we have been able to develop a decision rule that is likely to be cost-effective to the NHS," says Professor Mant. "Our economic analysis further suggested that if improvement in life expectancy was taken into account, then the optimum strategy would be to refer all patients with symptoms suggestive of heart failure directly for echocardiography."

Professor Mant went on to say "We hope that our analysis will help inform a review of the current NICE recommendation."

To view the full results visit hta.ac/1509

Source
National Institute for Health Research