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Exclude heart failure

Reduce unnecessary echo referrals…Improve the efficiency of your echo service.

It sounds simple if you say it quickly enough. However it can be done, and all within the primary care setting.

A significant number of patients being referred for echo with suspected heart failure, in fact, do not have heart failure. Some reports suggest that as many as 80% of echos are unnecessary. (1)

The two main groups of patients that this reflects are the obese and those with COPD. Both of these groups of patients can present with symptoms of shortness of breath and swelling of ankles (main symptoms of HF) but may NOT have HF. They are therefore taking up valuable appointments and creating unnecessary expense. 2003 NICE guidelines recommend BNP testing to help exclude heart failure. (2)

Furthermore, European Society of Cardiology 2008 guidelines on heart failure state ‘a normal BNP concentration in an untreated patient has a high negative predictive value and makes HF an unlikely cause of symptoms. This may play an important role especially in primary care.’ (3)

In practice, BNP testing is proven to rule out heart failure in mildly symptomatic patients, significantly reducing unnecessary echo referrals. (4)

A reduction in unnecessary referrals frees up appointments for other patients, significantly shortening the echo waiting list. Furthermore the BNP test can be done in a primary care setting with a simple to use Triage® system. The ability to provide a result within 15 minutes, safely ruling out heart failure, can have a significant impact on the patient experience and satisfaction with your service. Why utilize expensive secondary care services when you can have a quantitative lab-quality result within 15 minutes?  The Triage® System is used in over 6000 healthcare sites worldwide. “the adoption of BNP in primary care is likely to be clinically preferable, be more satisfactory for most patients, and lead to fewer unnecessary echocardiography referrals” (5)

References

1.Tackling Coronary Heart disease in Wales: Implementing through evidence, 2001

2.Management of Chronic Heart Failure in Adults in Primary and Secondary Care, NICE Guidelines CG5, 2003

3.ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, 2008

4.Early Diagnosis of Mild Heart Failure, Aspromonte et al. Clinical Chemistry 52, No. 9 2006

5.Cost-consequences analysis of natriuretic peptide assays to refute symptomatic heart failure in primary care, Scott et al. The British Journal of Cardiology, Volume 15, Issue 4 2008