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European Heart Journal Advance Access originally published online on March 15, 2005
European Heart Journal 2005 26(11):1086-1093; doi:10.1093/eurheartj/ehi178
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Using BNP to develop a risk score for heart failure in primary care

David Adlam1,*, Paul Silcocks2 and Nigel Sparrow3

1Department of Cardiovascular Medicine, Queen's Medical Centre, Nottingham, UK
2Trent Institute for Health Services Research, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
3Newthorpe Medical Practice, Nottingham, UK

Received 25 February 2004; revised 4 December 2004; accepted 27 January 2005; online publish-ahead-of-print 15 March 2005.

* Corresponding author. Tel: +44 1865 760 177. E-mail address: davidadlam{at}dcotors.org.uk

See page 1052 for the editorial comment on this article (doi:10.1093/eurheartj/ehi244)

Aims Chronic heart failure is a common condition with high mortality. Accurate diagnosis in primary care is difficult. Elevated B-type natriuretic peptide (BNP) is associated with left ventricular systolic dysfunction and increased mortality. Prognostic scoring systems using BNP may help to stratify risk in primary care patients. The aim of this research was to establish the independent variables which predict mortality in a primary care population-prescribed loop diuretics and to generate and validate a scoring system for heart failure in general practice.

Methods and results Five hundred and thirty-two patients were followed up for a mean of 6.4 years after attending a research clinic for clinical assessment, electrocardiogram (ECG), echocardiography, and BNP. Multivariate analysis was used to establish independent prognostic variables and to generate a prognostic scoring system. The score generated was [0.50xBNP+5xage+50x(CVA+sex+diabetes+ECG)]. The cut-off scores for risk groups were; 25th percentile, 411; 50th percentile, 475; 75th percentile, 524; Harrell's c=0.75.

Conclusion Developing prognostic scoring systems provides a means of risk stratifying patients without relying on a single cut-off diagnostic value for BNP. Further validation of such scoring systems may improve future management of community heart failure patients.

Key Words: Primary care • Heart failure • Brain natriuretic peptide • Echocardiography • Prognosis


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