Intended to establish the clinical utility and cost-effectiveness of B-type Natriuretic Peptide assay as a rule-out marker for heart failure in the hands of GPs and cardiologists
A pilot testing service using Bayer Diagnostics's new FDA-approved automated blood test for heart failure, B-type Natriuretic Peptide (BNP), has recently begun in Northamptonshire, funded by Northampton and Daventry and South Northants Primary Care Trusts.
This pilot of the Bayer assay is intended to establish the clinical utility and cost-effectiveness of BNP as a rule-out marker for heart failure in the hands of general practitioners and hospital cardiologists, potentially leading to the future provision of a BNP testing service in Northamptonshire on an open access basis.
This is the first time that the Bayer BNP assay has received PCT funding in the UK. Funding and implementation of the pilot testing service came about as a result of close collaboration between the two PCTs and the departments of cardiology and clinical biochemistry at Northampton General Hospital where the analysis of samples is being carried out.
The Bayer assay was chosen because it can be run on the hospital laboratory's automated Advia Centaur immunoassay system, making it easy for staff to process BNP alongside other routine analytes.
Samples from 1000 patients with suspected heart failure are being analysed in the trial, and results from the first 500 are expected to be audited in spring 2004.
Participating GPs have been issued with a BNP fact sheet and guidance notes about the service, covering requirements for sample submission and the interpretation of results.
GPs are asked to make requests for BNP measurement in accordance with the latest Nice guidelines for heart failure (July 2003) which recommend use of the test as a rule-out marker.
A label is attached to each sample providing clinical details of the patient for audit purposes, so that the clinical utility of the test can be assessed.
"The driving force for the Bayer BNP assay pilot was the PCTs' view that the diagnosis and management of heart failure were not being particularly well controlled", explains Nigel Scott, consultant clinical biochemist at Northampton General Hospital.
"Although money is available for GPs to send patients for an echocardiogram, the acute shortage of practitioners in this field means that this is not really a viable route to rapid diagnosis.
"With relatively few patients undergoing echocardiography, many were being prescribed Ace inhibitors without a thorough clinical investigation.
"We anticipate that BNP will provide a convenient substitute for echocardiography and thereby minimise unnecessary prescriptions.
"It is also hoped that some of the costs of BNP testing will be offset by a reduction in requirements for routine chest X-rays."
