The findings, published today in the European Heart Journal and funded by the National Institute for Health Research (NIHR) ARC OxTV and NIHR Community Healthcare MedTech and Invitro Diagnostics Co-operative, used data from over 1,000 general practices across the UK to examine how the use of a simple blood test administered by GPs varied over time, between 1 January 2004 and 31 December 2018.
Dr Clare Taylor, GP and NIHR Academic Clinical Lecturer at the Nuffield Department of Primary Care Health Sciences, University of Oxford said:
“As a GP I often see patients with heart failure. It is a serious, life-threatening condition that that affects around one million people in the UK alone. There are 200,000 new cases each year, and around 80% of these patients are only diagnosed when they are so unwell they’ve needed to be admitted to hospital.
As GPs we can do a simple blood test in primary care which tells us if heart failure is likely. If it’s raised, we can refer for a heart scan and assessment by a cardiologist. The heart failure detection rate in our study over a 14-year period remained the same, suggesting there are still missed opportunities for us to diagnose sooner through testing.
There are many treatments that improve both quality of life and survival, but we need to give them earlier so patients benefit sooner and avoid hospitalisation, which is why this testing is so important”
These tests, known as natriuretic peptides (NP), measure the concentration of specific hormones that help regulate blood volume. When the heart isn’t strong enough, it releases more of these hormones as a result of the pressure of having to work harder, which can be a sign of heart failure. These tests should be used by GPs to guide referral of patients showing symptoms of heart failure to a specialist for assessment in accordance with the recommended guidelines from the National Institute for Health and Care Excellence (NICE) in the UK.
Andrea Roalfe, first author and senior researcher in medical statistics at the Nuffield Department of Primary Care Health Sciences, University of Oxford, said:
“We found that whilst NP test rates increased over time – with a significant upward trend in 2010 when NICE strengthened their recommendation to do this testing – the proportion of patients without NP testing prior to diagnosis remained high (reducing from 99.6% in 2004 to 76.7% in 2017), and most new diagnoses were made without an NP test.”
The researchers also found that most testing occurs in patients with more advanced disease. This, they say, suggests that progress has not been made in testing to achieve a timely diagnosis, and that many patients with more subtle clinical symptoms and signs may not currently be tested.
“A very positive finding from this work was that there was no evidence of inequalities across the country or difference by socioeconomic status – meaning that whether NP testing was carried out did not depend on these factors,” said Dr Taylor. “We did see more NP testing in older and more socially deprived groups, which we expected since these groups are typically at a higher risk of heart failure so are more likely to be tested.”
The authors conclude that more NP testing is likely needed from GPs, to prevent hospitalisation and help to diagnose HF at an earlier, more treatable stage, thereby increasing people’s quality of life and survival. These tests should be done in people with heart failure symptoms, such as breathlessness, fatigue and ankle swelling.
- This research is reliant on the accuracy of coding by GPs during the consultation.
- The emergence of two distinct HF types, HFrEF and HFpEF, have only been coded very recently in GP records, therefore, analysis of trends by HF type were not possible in this study.
- This study did not consider the potential influence of medications prescribed or ‘comorbid’ conditions such as obesity and atrial fibrillation, which may be relevant to both HF diagnosis and NP result interpretation.
Andrea K Roalfe, Sarah L Lay-Flurrie, José M Ordóñez-Mena, Clare R Goyder, Nicholas R Jones, F D Richard Hobbs, Clare J Taylor, Long term trends in natriuretic peptide testing for heart failure in UK primary care: a cohort study, European Heart Journal, 2021;, ehab781, https://doi.org/10.1093/eurheartj/ehab781