Usefulness of natriuretic peptides in primary health care: An exploratory study in elderly patients

Abstract

Objective. To explore the negative predictive value (NPV), positive predictive value (PPV), sensitivity, and specificity of natriuretic peptides, cut-off levels, and the impact of gender and age in elderly patients with systolic heart failure (HF). Design. Cross-sectional exploratory study. Setting. One primary healthcare centre. Patients. A total of 109 patients with symptoms of HF were referred for echocardiographic examination with a cardiovascular consultation. Systolic HF was diagnosed (ESC guidelines) in 48 patients (46% men, 54% women, mean age 79 years) while 61 patients (21% men, 79% women, mean age 76 years) had no HF. Main outcome measures. NPV, PPV, sensitivity, specificity, and cut-off levels. Results. Including all 109 patients, NPV was 88% for NT-proBNP (200 ng/L) and 87% for BNP (20 pg/ml). PPV was 81% for NT-proBNP (500 ng/L) and 68% for BNP (50 pg/ml). Sensitivity was 96% for NT-proBNP (100 ng/L) and 96% for BNP (10-20 pg/ml). Specificity was 87% for NT-proBNP (500 ng/L) and 71% for BNP (50 pg/ml). Nt-proBNP (β = 0.035; p < 0.001) and BNP (β = 0.030; p < 0.001) were associated with age, but not with gender. In a multivariate analysis age (β = 0.036; p < 0.001) and male gender (β = 0.270; p = 0.014) were associated with NT-proBNP, but only age for BNP (β = 0.030; p < 0.001). Conclusion. Natriuretic peptides in an elderly population showed high NPVs, but not as high as in younger patients with HF in other studies. Age and male gender were associated with higher levels of NT-proBNP while only age was related to elevated BNP levels.

Key Words::

• Echocardiography
• elderly
• family practice
• gender
• natriuretic peptides
• primary health care
• systolic heart failure

Acknowledgements

This study was supported by a research grant from Västerbotten County Council, Foundation of Medical Research, Skellefteå and an unrestricted grant by Novartis Sweden AB. The authors would like to thank MD Thomas Suh, Skellefteå, for linguistic assistance.

Patients signed written consent for the study and the study was approved by the Committee of Ethics at Umeå University.

The authors have no conflict of interest.