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BMJ. 2018 May 21;361:k1450. doi: 10.1136/bmj.k1450.

Diagnostic accuracy of point-of-care natriuretic peptide testing for chronic heart failure in ambulatory care: systematic review and meta-analysis.

Author information

1
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
2
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK annette.pluddemann@phc.ox.ac.uk.

Abstract

OBJECTIVE:

To assess the diagnostic accuracy of point-of-care natriuretic peptide tests in patients with chronic heart failure, with a focus on the ambulatory care setting.

DESIGN:

Systematic review and meta-analysis.

DATA SOURCES:

Ovid Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Embase, Health Technology Assessment Database, Science Citation Index, and Conference Proceedings Citation Index until 31 March 2017.

STUDY SELECTION:

Eligible studies evaluated point-of-care natriuretic peptide testing (B-type natriuretic peptide (BNP) or N terminal fragment pro B-type natriuretic peptide (NTproBNP)) against any relevant reference standard, including echocardiography, clinical examination, or combinations of these, in humans. Studies were excluded if reported data were insufficient to construct 2×2 tables. No language restrictions were applied.

RESULTS:

42 publications of 39 individual studies met the inclusion criteria and 40 publications of 37 studies were included in the analysis. Of the 37 studies, 30 evaluated BNP point-of-care testing and seven evaluated NTproBNP testing. 15 studies were done in ambulatory care settings in populations with a low prevalence of chronic heart failure. Five studies were done in primary care. At thresholds >100 pg/mL, the sensitivity of BNP, measured with the point-of-care index device Triage, was generally high and was 0.95 (95% confidence interval 0.90 to 0.98) at 100 pg/mL. At thresholds <100 pg/mL, sensitivity ranged from 0.46 to 0.97 and specificity from 0.31 to 0.98. Primary care studies that used NTproBNP testing reported a sensitivity of 0.99 (0.57 to 1.00) and specificity of 0.60 (0.44 to 0.74) at 135 pg/mL. No statistically significant difference in diagnostic accuracy was found between point-of-care BNP and NTproBNP tests.

CONCLUSIONS:

Given the lack of studies in primary care, the paucity of NTproBNP data, and potential methodological limitations in these studies, large scale trials in primary care are needed to assess the role of point-of-care natriuretic peptide testing and clarify appropriate thresholds to improve care of patients with suspected or chronic heart failure.

PMID:
29785952
PMCID:
PMC5960954
DOI:
10.1136/bmj.k1450
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: KST reports grants from NIHR during the conduct of the study; JYV reports grants from NIHR DEC, during the conduct of the study; BGF reports grants from NIHR, during the conduct of the study; CPP reports funding from an NIHR grant and occasionally receipt of honorariums and expenses for speaking at meetings, and writing white papers on the generic topic of point-of-care testing; RP reports grants from NIHR UK programme of applied research during the conduct of the study; CB reports grants from NIHR programme grant for applied research, grants from NIHR School of Primary Care Research, grants from Biomedical Research Centre, Oxford during the conduct of the study; AP reports grants from NIHR and from NIHR School of Primary Care Research during the conduct of the study, and occasionally receives expenses for teaching evidence based medicine.

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