• G Mak, M Ryder, N F Murphy, C O'Loughlin, D McCaffrey, M Ledwidge, and K McDonald.
• Heart Failure Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, UK. drgeorgemak@yahoo.com
• Ir J Med Sci. 2008 Sep 1;177(3):197-203.

BackgroundBrain natriuretic peptide (BNP) may help general practitioners (GPs) to "rule-out" heart failure (HF) and reduce referral burden on specialist assessment clinics.AimsTo determine the diagnostic value of BNP in HF referrals by GPs to a specialist unit.MethodsFrom 2003 to 2007, 327 GP referrals were made to a HF new patient diagnostic clinic (NDC) with a provisional diagnosis of HF. The NDC provides rapid assessment of potential HF patients and ensures appropriate therapy and follow-up for those with a confirmed diagnosis. HF diagnosis was confirmed by the Framingham criteria.ResultsHF was present in 39% of cases referred (mean age 75 +/- 10 years, 49% male). The inclusion of BNP as a "rule-out" test with a cut-off value of 100 pg/mL would have reduced the number of patients originally referred to the NDC by 175. However, this would have resulted in delayed diagnosis and treatment of 20 (16%) "false-negative" patients.ConclusionsAvailability of BNP to GPs would improve referral patterns but with high risk of delayed diagnosis. The data underline the need for a shared-care approach to the new diagnosis of HF.

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