Original article Rapid Point-of-Care NT-proBNP Optimal Cut-off Point for Heart Failure Diagnosis in Primary Care Jose ´ M. Verdu ´, a,b, * Josep Comı ´n-Colet, b,c Mar Domingo, d,e Josep Lupo ´ n, b,f Miguel Go ´ mez, b,g Luis Molina, b,g Jose M. Casacuberta, a Miguel A. Mun ˜oz, b,h Amparo Mena, i and Jordi Bruguera-Cortada g a Equip d’Atencio ´ Prima `ria Sant Martı´ de Provenc ¸als, Institut Catala ` de la Salut, Barcelona, Spain b Facultat de Medicina, Universitat Auto `noma de Barcelona, Barcelona, Spain c Programa d’Insuficie `ncia Cardiaca, Servei de Cardiologia, Hospital del Mar (Parc de Salut Mar), Barcelona, Spain d Equip d’Atencio ´ Prima `ria Sant Roc, Institut Catala ` de la Salut, Badalona, Barcelona, Spain e Unitat de Suport a la Recerca Metropolitana Nord, Institut d’Investigacio ´ en Atencio ´ Prima `ria Jordi Gol, Institut Catala ` de la Salut, Barcelona, Spain f Unitat d’Insuficie `ncia Cardiaca, Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain g Servei de Cardiologia, Hospital del Mar (Parc de Salut Mar), Barcelona, Spain h Unitat de Suport a la Recerca de Barcelona, Institut d’Investigacio ´ en Atencio ´ Prima `ria Jordi Gol, Institut Catala ` de la Salut, Barcelona, Spain i Equip d’Atencio ´ Prima `ria Congre ´s, Institut Catala ` de la Salut, Barcelona, Spain Rev Esp Cardiol. 2012;65(7):613–619 Article history: Received 28 November 2011 Accepted 11 January 2012 Available online 26 April 2012 Keywords: Heart failure Natriuretic peptides Diagnosis Primary care A B S T R A C T Introduction and objectives: Measurement of natriuretic peptides may be recommended prior to echocardiography in patients with suspected heart failure. Cut-off point for heart failure diagnosis in primary care is not well established. We aimed to assess the optimal diagnostic cut-off value of N- terminal pro-B-type natriuretic peptide on a community population attended in primary care. Methods: Prospective diagnostic accuracy study of a rapid point-of-care N-terminal pro-B-type natriuretic peptide test in a primary healthcare centre. Consecutive patients referred by their general practitioners to echocardiography due to suspected heart failure were included. Clinical history and physical examination based on Framingham criteria, electrocardiogram, chest X-ray, N-terminal pro-B-type natriuretic peptide measurement and echocardiogram were performed. Heart failure diagnosis was made by a cardiologist blinded to N-terminal pro-B-type natriuretic peptide value, using the European Society of Cardiology diagnosis criteria (clinical and echocardiographic data). Results: Of 220 patients evaluated (65.5% women; median 74 years [interquartile range 67-81]). Heart failure diagnosis was confirmed in 52 patients (23.6%), 16 (30.8%) with left ventricular ejection fraction <50% (39.6 [5.1]%). Median values of N-terminal pro-B-type natriuretic peptide were 715 pg/mL [interquartile range 510.5-1575] and 77.5 pg/mL [interquartile range 58-179.75] for patients with and without heart failure respectively. The best cut-off point was 280 pg/mL, with a receiver operating characteristic curve of 0.94 (95% confidence interval, 0.91-0.97). Six patients with heart failure diagnosis (11.5%) had N-terminal pro-B-type natriuretic peptide values <400 pg/mL. Measurement of natriuretic peptides would avoid 67% of requested echocardiograms. Conclusions: In a community population attended in primary care, the best cut-off point of N-terminal pro-B-type natriuretic peptide to rule out heart failure was 280 pg/mL. N-terminal pro-B-type natriuretic peptide measurement improve work-out diagnosys and could be cost-effectiveness. ß 2012 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L. All rights reserved. Punto de corte o ´ ptimo de NT-proBNP para el diagno ´ stico de insuficiencia cardiaca mediante un test de determinacio ´n ra ´ pida en atencio ´n primaria Palabras clave: Insuficiencia cardiaca Pe ´ ptidos natriure ´ ticos Diagno ´ stico Atencio ´n primaria R E S U M E N Introduccio ´n y objetivos: La determinacio ´n de pe ´ ptidos natriure ´ ticos puede estar recomendada como paso previo al ecocardiograma ante la sospecha de insuficiencia cardiaca. El punto de corte o ´ ptimo para el diagno ´ stico de insuficiencia cardiaca en atencio ´n primaria no esta ´ completamente definido. El objetivo es determinar dicho punto de corte. Me ´todos: Es un estudio prospectivo para evaluar un test ra ´ pido local de fraccio ´n N-terminal del pe ´ ptido natriure ´ tico tipo B en atencio ´n primaria. Se incluyo ´ a pacientes con solicitud de ecocardiograma realizada por un me ´ dico de familia ante la sospecha clı ´nica de insuficiencia cardiaca. Se realizo ´ historia clı ´nica y exploracio ´n fı ´sica basadas en los criterios de Framingham, electrocardiograma, radiografı ´a de to ´ rax, determinacio ´n de fraccio ´n N-terminal del pe ´ ptido natriure ´ tico tipo B y ecocardiograma. El diagno ´ stico de insuficiencia cardiaca fue establecido por un cardio ´ logo ciego al valor de fraccio ´n N- terminal del pe ´ ptido natriure ´ tico tipo B, utilizando los criterios de la Sociedad Europea de Cardiologı ´a (clı ´nica y confirmacio ´n ecocardiogra ´ fica). * Corresponding author: Equip d’Atencio ´ Prima ` ria Sant Martı ´ de Provenc ¸als, Fluvia ` 211, 08020 Barcelona, Spain. E-mail address: verdujm@gmail.com (J.M. Verdu ´ ). 1885-5857/$ – see front matter ß 2012 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L. All rights reserved. doi:10.1016/j.rec.2012.01.021