Time trends in the use and appropriateness of natriuretic peptide testing in primary care: an observational study

The letters E to L correspond to the following events: (E) 2005: Update of the Dutch GPs’ guidelines on heart failure (HF), now mentioning NTproBNP and BNP as an option in the diagnostic assessment. Also in this year an update of the European Society of Cardiology (ESC) guidelines on HF. (F) 2006: Patient reimbursement stopped for laboratory testing. (G) 2008: Update of the ESC guidelines on HF, clearly recommending natriuretic peptides (NPs) for diagnosis, but without advocating a cut-point. (H) 2009: Single-day training on the diagnosis of HF and the use of NTproBNP of the participating GPs of Soest. (I) 2010: Update of the Dutch GPs’ guidelines on HF, now recommending the use of the NTproBNP exclusionary cut-point of 125 pg/ml (approximately 15 mmol/l). If values are below this threshold, and the electrocardiogram is normal, than HF is very unlikely and other diagnoses should be considered to explain the symptoms of patients. (J) 2011: Regional agreement on open-access echocardiography in the Soest area. (K) 2011: Regional agreement between GPs and cardiologists on HF referral, diagnosis, and management in the Soest area. (L) 2012: Update of the ESC guidelines on HF, now also explicitly recommending the exclusionary cut-point of 125 pg/ml (approximately 15 mmol/l) for NTproBNP