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

Figures & data

Figure 1. Flowchart over patient population.

Table I. Baseline characteristics, comorbidities, and treatment of 48 patients with systolic HF and 61 patients in the reference group.

	Patients with systolic HF (n = 48)	Reference group (n = 61)
Mean age (±SD)	79 (6,4)	76 (8,6)
> 79 years, n (%)	24 (50)	27 (44)
Male, n (%)	22 (46)	13 (21)
Female, n (%)	26 (54)	48 (79)
Myocardial infarction, n (%)	14 (29)	8 (13)
Hypertension, n (%)	23 (48)	20 (33)
Angina, n (%)	19 (40)	18 (30)
Atrial fibrillation, n (%)	14 (29)	5 (8)
Valvular heart disease, n (%)	9 (19)	9 (15)
ACE or AII, n (%)	21 (44)	14 (23)
BB, n (%)	28 (58)	22 (36)
Diuretic, n (%)	25 (52)	32 (52)
ACE + diuretic, n (%)	13 (27)	6 (10)
ACE + diuretic
+ BB, n (%)	6 (13)	3 (5)

Notes: ACE = angiotensin converting enzyme inhibitor, ARB = angiotensin-II receptor blocker; BB = beta receptor blocker.

Table II. Negative predictive value (NPV), positive predictive value (PPV), sensitivity, and specificity, respectively, and odds ratio (OR) and its confidence interval (CI) of having HF at different cut-off values for NT-proBNP and BNP in 48 patients with systolic HF and 61 referent patients.

NT-proBNP, ng/l	100	200	300	400	500
NPV, % (n)	85 (11/13)	88 (28/32)	82 (42/51)	81 (50/62)	80 (53/66)
PPV, % (n)	48 (46/96)	57 (44/77)	67 (39/58)	77 (36/47)	81 (35/43)
Sensitivity, % (n)	96 (46/48)	92 (44/48)	81 (39/48)	75 (36/48)	73 (35/48)
Specificity, % (n)	18 (11/61)	46 (28/61)	69 (42/61)	82 (50/61)	87 (53/61)
OR of HF	5.0	9.3	9.6	13.6	17.8
CI 95 %	1.0–24.0	2.9–29.2	3.9–23.7	5.4–34.3	6.7–47.5
BNP pg/ml	10	20	30	40	50
NPV, % (n)	60 (3/5)	87 (13/15)	85 (23/27)	83 (33/40)	81 (43/53)
PPV, % (n)	44 (46/104)	49 (46/94)	54 (44/82)	59 (41/69)	68 (38/56)
Sensitivity, % (n)	96 (46/48)	96 (46/48)	92 (44/48)	85 (41/48)	79 (38/48)
Specificity, % (n)	5 (3/61)	21 (13/61)	38 (23/61)	54 (33/61)	71 (43/61)
OR of HF	1.2	6.2	6.6	6.9	9.1
CI 95 %	0.2-7.4	1.3-29.1	2.1-21.0	2.7-17.8	3.7-22.0

Table III. Negative predictive value (NPV), positive predictive value (PPV), sensitivity (sens) and specificity (spec), of different cut-off values for NT-proBNP.

NT-proBNP, ng/L	100		200		300		400		500
< = 79 years	Men	Women	Men	Women	Men	Women	Men	Women	Men	Women
NPV, %	100	78	83	84	78	79	80	79	73	79
(n)	(3/3)	(7/9)	(5/6)	(16/19)	(7/9)	(19/24)	(8/10)	(22/28)	(8/11)	(23/29)
PPV, %	63	40	69	55	80	60	89	73	88	80
(n)	(10/16)	(12/30)	(9/13)	(11/20)	(8/10)	(9/15)	(8/9)	(8/11)	(7/8)	(8/10)
Sens, %	100	86	90	79	80	64	80	57	70	57
(n)	(10/10)	(12/14)	(9/10)	(11/14)	(8/10)	(9/14)	(8/10)	(8/14)	(7/10)	(8/14)
Spec, %	33	28	56	64	78	76	89	88	89	92
(n)	(3/9)	(7/25)	(5/9)	(16/25)	(7/9)	(19/25)	(8/9)	(22/25)	(8/9)	(23/25)
> 79 years
NPV, %	100		100	100	100	100	67	86	80	86
(n)	(1/1)	(0/0)	(2/2)	(5/5)	(2/2)	(14/16)	(2/3)	(18/21)	(4/5)	(18/21)
PPV, %	80	34	86	40	86	53	85	64	100	64
(n)	(12/15)	(12/35)	(12/14)	(12/30)	(12/14)	(10/19)	(11/13)	(9/14)	(11/11)	(9/14)
Sens, %	100	100	100	100	100	83	92	75	92	75
(n)	(12/12)	(12/12)	(12/12)	(12/12)	(12/12)	(10/12)	(11/12)	(9/12)	(11/12)	(9/12)
Spec, %	25		50	22	50	61	50	78	100	78
(n)	(1/4)	(0/23)	(2/4)	(5/23)	(2/4)	(14/23)	(2/4)	(18/23)	(4/4)	(18/23)

Note: A total of 19 men and 39 women < 79 years and 16 men and 35 women = > 79 years were studied.

Table IV. Negative predictive value (NPV), positive predictive value (PPV), sensitivity (sens) and specificity (spec), of different cut-off values for BNP.

BNP pg/mL	10		20		30		40		50
< = 79 years	Men	Women	Men	Women	Men	Women	Men	Women	Men	Women
NPV, %		75	67	90	80	87	75	84	80	76
(n)	0/1	(3/4)	(2/3)	(9/10)	(4/5)	(13/15)	(6/8)	(16/19)	(8/10)	(19/25)
PPV, %	50	37	56	45	64	50	73	55	89	57
(n)	(9/18)	(13/35)	(9/16)	(13/29)	(9/14)	(12/24)	(8/11)	(11/20)	(8/9)	(8/14)
Sens, %	90	93	90	93	90	86	80	79	80	57
(n)	(9/10)	(13/14)	(9/10)	(13/14)	(9/10)	(12/14)	(8/10)	(11/14)	(8/10)	(8/14)
Spec, %		12	22	36	44	52	67	64	89	76
(n)	(0/9)	(3/25)	(2/9)	(9/25)	(4/9)	(13/25)	(6/9)	(16/25)	(8/9)	(19/25)
> 79 years
NPV, %			67		80	80	75	82	80	88
(n)	(0/0)	(0/0)	(2/3)	(0/0)	(4/5)	(4/5)	(6/8)	(9/11)	(8/10)	(14/16)
PPV, %	75	34	56	34	64	37	73	42	89	53
(n)	(12/16)	(12/35)	(9/16)	(12/35)	(9/14)	(11/30)	(8/11)	(10/24)	(8/9)	(10/19)
Sens, %	100	100	100	100	100	92	100	83	100	83
(n)	(12/12)	(12/12)	(12/12)	(12/12)	(12/12)	(11/12)	(12/12)	(10/12)	(12/12)	(10/12)
Spec, %			50		50	17	50	39	50	61
(n)	(0/4)	(0/23)	(2/4)	(0/23)	(2/4)	(4/23)	(2/4)	(9/23)	(2/4)	(14/23)

Note: A total of 19 men and 39 women < 79 years and 16 men and 35 women = >79 years were studied.