Document Detail

Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care.
MedLine Citation:
PMID:  9365448     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The reliability of a clinical diagnosis of heart failure in primary care is poor. Concentrations of natriuretic peptides are high in heart failure. This population-based study examined the predictive value of natriuretic peptides in patients with a new primary-care diagnosis of heart failure. METHODS: Concentrations of plasma atrial (ANP and N-terminal ANP) and B-type (BNP) natriuretic peptides were measured by radioimmunoassay in 122 consecutive patients referred to a rapid-access heart-failure clinic with a new primary-care diagnosis of heart failure. On the basis of clinical assessment, chest radiography, and transthoracic echocardiography, a panel of three cardiologists decided that 35 (29%) patients met the case definition for new heart failure. ANP and NT-ANP results were available for 117 patients (34 with heart failure) and BNP results for 106 (29 with heart failure). FINDINGS: Geometric mean concentrations of natriuretic peptides were much higher in patients with heart failure than in those with other diagnoses (29.2 vs 12.4 pmol/L for ANP; 63.9 vs 13.9 pmol/L for BNP; 1187 vs 410.6 pmol/L for NT-ANP; all p < 0.001). At cut-off values chosen to give negative predictive values for heart failure of 98% (ANP > or = 18.1 pmol/L, NT-ANP > or = 537.6 pmol/L, BNP > or = 22.2 pmol/L), the sensitivity, specificity, and positive predictive value for ANP were 97%, 72%, and 55%; for NT-ANP 97%, 66%, and 54%; and for BNP 97%, 84%, and 70%. Addition of ANP or NT-ANP concentration or both did not improve the predictive power of a logistic regression model containing BNP concentration alone. INTERPRETATION: In patients with symptoms suspected by a general practitioner to be due to heart failure, plasma BNP concentration seems to be a useful indicator of which patients are likely to have heart failure and require further clinical assessment.
M R Cowie; A D Struthers; D A Wood; A J Coats; S G Thompson; P A Poole-Wilson; G C Sutton
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet     Volume:  350     ISSN:  0140-6736     ISO Abbreviation:  Lancet     Publication Date:  1997 Nov 
Date Detail:
Created Date:  1997-12-05     Completed Date:  1997-12-05     Revised Date:  2009-09-29    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1349-53     Citation Subset:  AIM; IM    
Imperial College School of Medicine, National Heart and Lung Institute, London, UK.
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MeSH Terms
Aged, 80 and over
Atrial Natriuretic Factor / blood*
Heart Failure / blood,  diagnosis*
Middle Aged
Primary Health Care
Reproducibility of Results
Grant Support
//Wellcome Trust
Reg. No./Substance:
85637-73-6/Atrial Natriuretic Factor
Comment In:
Lancet. 1998 Feb 7;351(9100):444; author reply 445   [PMID:  9482328 ]
Lancet. 1998 Feb 7;351(9100):444-5; author reply 445   [PMID:  9482329 ]
Lancet. 1998 Jan 31;351(9099):371; author reply 371-2   [PMID:  9652647 ]
Lancet. 1998 Feb 7;351(9100):444; author reply 445   [PMID:  9482327 ]
Lancet. 1998 Feb 7;351(9100):444; author reply 445   [PMID:  9482326 ]

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