Clinical applicability of B-type natriuretic peptide in patients with suspected heart failure in primary care in Spain: the PANAMA study

Abstract

Aim: To assess the predictive value of B-type natriuretic peptide (BNP) in the diagnosis of heart failure (HF) in a primary-care setting in Spain. Methods: PANAMA was a multicenter and cross-sectional study. Patients ≥18 years of age with a clinical diagnosis of HF (Framingham criteria) were consecutively included in the study by primary-care investigators. BNP determination and an echocardiogram were performed in every patient. The cut-off point of BNP for the criterion of exclusion of HF was considered as <100 pg/ml, as suggested by European guidelines. Sensitivity, specificity, positive-predictive value and negative-predictive value were calculated. Results: A total of 72 patients (mean age: 75.1 ± 8.7 years; 74.6% women) were included. The most frequent associated risk factors were hypertension (75.6%) and dyslipidemia (54.3%). The most common major and minor criteria of HF according to Framingham criteria were radiographic cardiomegaly (90.2%) and dyspnea on ordinary exertion (100%), respectively. BNP median was 49 pg/ml (33.3 pg/ml in those with a doubtful diagnosis of HF and 83.3 pg/ml in those with a likely diagnosis of HF). Approximately 60% of patients exhibited diastolic dysfunction. Concerning accuracy parameters comparing BNP >100 pg/ml with echocardiogram, sensitivity was 25%, the specificity 80.8%, and the positive- and negative-predictive values were 68.8 and 38.9%, respectively. Conclusion: In patients attended by general practitioners, BNP >100 pg/ml may be a useful diagnostic tool with a high specificity for the diagnosis of HF.

Keywords::

• BNP
• echocardiogram
• heart failure
• primary care

Acknowledgements

The authors wish to express their most sincere gratitude to all investigators who have actively participated in this study. Without their dedication and quality of work, this publication would not have been possible.

Financial & competing interests disclosure

This study was supported by Almirall, Spain. All data have been recorded and analyzed independently to prevent bias. Arantxa Matali is a medical doctor who works at Almirall-Prodesfarma pharmaceuticals, Spain. The affiliation of this author is clearly disclosed in the by-line. All data have been recorded and analyzed independently to prevent bias. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.