TY - JOUR T1 - Time trends in the use and appropriateness of natriuretic peptide testing in primary care: an observational study JF - BJGP Open JO - BJGP Open DO - 10.3399/bjgpopen20X101074 VL - 4 IS - 4 SP - bjgpopen20X101074 AU - Mark Valk AU - Arno W Hoes AU - Arend Mosterd AU - Brenda Broekhuizen AU - Nicolaas Zuithoff AU - Frans H Rutten Y1 - 2020/10/01 UR - http://bjgpopen.org/content/4/4/bjgpopen20X101074.abstract N2 - Background Diagnosing heart failure (HF) is difficult, relying on medical history, symptoms, and signs only. Clinical guidelines recommend natriuretic peptides (NPs) as an additional diagnostic test, notably to exclude HF in suspected patients. NP testing has been available since 2003 for primary care in the Netherlands, but little is known about its uptake.Aim To evaluate the trend in ordering and appropriateness of NP testing in primary care.Design & setting An observational study was performed between January 2005 and December 2013. Nine Dutch general practices participated, with 21 000 registered people (approximately 4300 aged ≥65 years).Method The total number of patients undergoing NP testing each year was calculated per 1000 patient years (PY) based on the total practice population. NP levels were used to assess whether NP testing was applied to exclude or confirm HF.Results The number of NP testing increased from 2.5 per 1000 PY in 2005 to 14.0 per 1000 PY in 2013, with a peak in 2009 of 15.6 per 1000 PY. The proportion of participants with N-terminal B-type natriuretic peptide (NTproBNP) below 125 pg/ml (the exclusionary threshold recommended by the European Society of Cardiology [ESC] guidelines on HF) was on average 30%, and highest in the first year (47%).Conclusion After a rapid uptake of NP testing in primary care from 2005 onwards, the use of it seemed to stabilise after 2009, thus leaving patients who are prone to HF without an optimal diagnostic work-up. ER -