Quality standard

Quality statement 1: N-terminal pro-B-type natriuretic peptide measurement

Quality statement 1: N-terminal pro-B-type natriuretic peptide measurement

Quality statement

Adults presenting in primary care with suspected heart failure have their N‑terminal pro‑B‑type natriuretic peptide (NT‑proBNP) measured. [new 2023]

Rationale

N‑terminal pro‑B‑type natriuretic peptide measurement in primary care can confirm whether heart failure is likely when it is suspected and there is no existing diagnosis of heart failure. People can then be referred for specialist assessment and echocardiography, begin appropriate treatment at an earlier point in their illness, and lower their risk of hospitalisation and mortality.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of adults diagnosed with heart failure by specialist assessment and echocardiography who had NT‑proBNP measured before diagnosis.

Numerator – the number in the denominator who had NT‑proBNP measured before diagnosis.

Denominator – the number of adults diagnosed with heart failure by specialist assessment and echocardiography.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Hospital admissions due to heart failure.

Data source: The National Heart Failure Audit contains data on hospital admission rates for heart failure.

What the quality statement means for different audiences

Service providers (primary care) ensure that systems are in place to measure NT‑proBNP when heart failure is suspected in adults.

Healthcare professionals (such as GPs, practice nurses) ensure that when they suspect heart failure in adults, they arrange or carry out NT‑proBNP measurement.

Commissioners (integrated care systems) ensure that NT‑proBNP testing is available in primary care settings.

Adults with suspected heart failure have a blood test by their GP or practice nurse to find out how well their heart is working.

Definitions of terms used in this quality statement

Adults with suspected heart failure

Adults may be suspected of having heart failure after being:

  • Asked about symptoms:

    • breathlessness – on exertion, at rest, on lying flat (orthopnoea), nocturnal cough, or waking from sleep (paroxysmal nocturnal dyspnoea)

    • fluid retention (ankle swelling, bloated feeling, abdominal swelling, or weight gain)

    • fatigue, decreased exercise tolerance, or increased recovery time after exercise

    • light headedness or history of syncope (fainting).

  • Asked about risk factors:

    • coronary artery disease including previous history of myocardial infarction, hypertension, atrial fibrillation and diabetes mellitus

    • drugs use, including alcohol

    • family history of heart failure or sudden cardiac death under the age of 40 years.

  • And examined for:

    • tachycardia (heart rate over 100 beats per minute) and pulse rhythm

    • a laterally displaced apex beat, heart murmurs, and third or fourth heart sounds (gallop rhythm)

    • hypertension; for more information, see NICE's clinical knowledge summary on hypertension

    • raised jugular venous pressure

    • enlarged liver (due to engorgement)

    • respiratory signs such as tachypnoea, basal crepitations, and pleural effusions

    • dependent oedema (legs, sacrum), ascites

    • obesity; for more information, see NICE's clinical knowledge summary on obesity.

[Adapted from NICE's clinical knowledge summary on chronic heart failure]