Relations between medical history, clinical findings and plasma N-terminal proatrial natriuretic peptide in patients in primary health care

• Published in: European journal of heart failure Vol. 3; no. 3; pp. 307 - 313
• Main Authors: Smith, Jørgen A., Bruusgaard, Dag, Bodd, Egil, Hall, Christian
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.06.2001; Elsevier
• Subjects: Aged; Aged, 80 and over; Atrial Natriuretic Factor - blood; Female; general practice; heart failure; Heart Failure - blood; Humans; Male; Medical History Taking - methods; natriuretic peptides; Norway; Predictive Value of Tests; Primary Health Care; Protein Precursors - blood; Regression Analysis; Norway; Heart failure; General practice; Natriuretic peptides
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1016/S1388-9842(01)00124-6

Background: recent studies indicate that measurement of natriuretic peptides may be a valuable tool to improve the quality of the diagnosis of heart failure in general practice. Aim: the aim of the present study was to examine the relationship between the plasma level of the natriuretic peptide N-terminal proANP and symptoms and signs of heart failure in patients from general practice in the Oslo area. Methods and Results: we undertook a survey of 499 patients consecutively enrolled from the practice of 27 practitioners. One hundred and twenty-nine patients were classified as having possible or some degree of heart failure. The plasma concentration of N-terminal proANP increased with severity of heart failure as judged from clinical examination. In multivariate analysis age, history of heart disease, plasma creatinine, use of beta-blockers and digitalis, oedemas and atrial fibrillation were the main determinants of plasma N-terminal proANP. Conclusion: while there was an overall increase in N-terminal proANP values with increasing symptoms and degree of heart failure, no single finding was closely related to N-terminal proANP. Treatment effects and diagnostic errors may both influence the relationship between N-terminal proANP and clinical findings. The current study has demonstrated the feasibility of using N-terminal proANP by general practitioners for the potentially improved diagnosis of heart failure. Further research is required to determine the precise role of this assay in clinical practice.