RESEARCH ARTICLE


The Ability of Heart Failure Specialists to Accurately Predict NT-proBNP Levels Based on Clinical Assessment and a Previous NT-proBNP Measurement



Tara L Sedlak 1, Mann Chandavimol2, Anna Calleja3, Catherine Clark4, Margaret Edmonds5, Aihua Pu6, Karin H Humphries7, Andrew Ignaszewski*, 8
1 University of British Columbia
2 University of British Columbia
3 University of British Columbia
4 St. Paul’s Hospital, Vancouver
5 St. Paul’s Hospital, Vancouver
6 Centre for Health Evaluation & Outcome Sciences
7 University of British Columbia, Centre for Health Evaluation & Outcome Sciences
8 University of British Columbia


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© Sedlak et al.; Licensee Bentham Open

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/), which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Health Heart Program, 1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; Tel: 604-806-8605; Fax: 604-806-8338; E-mail: aignaszewski@providencehealth.bc.ca


Abstract

Background:

The value of routine aminoterminal pro type B natriuretic peptide (NT-proBNP) measurements in outpatient clinics remains unknown.

Objectives:

We sought to determine the accuracy with which heart failure (HF) specialists can predict NT-proBNP levels in HF outpatients based on clinical assessment.

Methods:

We prospectively studied 160 consecutive HF patients followed in an outpatient multidisciplinary HF clinic. During a regular office visit, HF specialists were asked to estimate a patient’s current NT-proBNP level based upon their clinical assessment and all available information from their chart, including a previous NT-proBNP level (if available). NT-proBNP estimations were grouped into prognostic categories (<125, 125-1000, 1000-4998, or ≥4999 pg/mL) and comparisons made between actual and estimate values.

Results:

Overall, HF specialists estimated 67.5% of NT-proBNP levels correctly. After adjusting for clinical characteristics, knowledge of a prior NT-proBNP measurement was the only significant predictor of estimation accuracy (p=0.01). Compared to patients with a prior NT-proBNP level <125 pg/mL, physicians were 95% less likely to get a correct estimation in patients with the highest prior NT-proBNP level (≥4999 pg/mL).

Conclusion:

HF specialists are reasonably accurate at estimating current NT-proBNP levels based upon clinical assessment and a previous NT-proBNP level, if those levels were < 4999 pg/mL. Likely, initial but not routine NT-proBNP measurements are useful in outpatient HF clinics.