Aims Heart failure (HF) is a malignant condition with poor outcomes and is often diagnosed on emergency hospital admission. Natriuretic peptide (NP) testing in primary care is recommended in international guidelines to facilitate timely diagnosis. We aimed to report contemporary trends in NP testing and subsequent HF diagnosis rates over time. Methods and results Cohort study using linked primary and secondary care data of adult (≥45 years) patients in England 2004–18 (n = 7 212 013, 48% male) to report trends in NP testing (over time, by age, sex, ethnicity, and socioeconomic status) and HF diagnosis rates. NP test rates increased from 0.25 per 1000 person-years [95% confidence interval (CI) 0.23–0.26] in 2004 to 16.88 per 1000 person-years (95% CI 16.73–17.03) in 2018, with a significant upward trend in 2010 following publication of national HF guidance. Women and different ethnic groups had similar test rates, and there was more NP testing in older and more socially deprived groups as expected. The HF detection rate was constant over the study period (around 10%) and the proportion of patients without NP testing prior to diagnosis remained high [99.6% (n = 13 484) in 2004 vs. 76.7% (n = 12 978) in 2017]. Conclusion NP testing in primary care has increased over time, with no evidence of significant inequalities, but most patients with HF still do not have an NP test recorded prior to diagnosis. More NP testing in primary care may be needed to prevent hospitalization and facilitate HF diagnosis at an earlier, more treatable stage.

中文翻译：

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英国初级保健中心力衰竭利钠肽检测的长期趋势：一项队列研究


目的 心力衰竭（HF）是一种预后不良的恶性疾病，通常在紧急入院时被诊断出来。国际指南建议在初级保健中进行利钠肽（NP）检测，以促进及时诊断。我们的目的是报告 NP 检测的当代趋势以及随后的 HF 诊断率随时间的变化。方法和结果 队列研究使用 2004-18 年英格兰成年（≥ 45 岁）患者（n = 7 212 013，48% 男性）的初级和二级护理相关数据来报告 NP 检测趋势（随时间、按年龄、性别） 、种族和社会经济地位）和心力衰竭诊断率。 NP测试率从2004年的0.25/1000人年[95%置信区间(CI) 0.23-0.26]增加到2018年的16.88/1000人年(95% CI 16.73-17.03)，2010年呈显着上升趋势国家高频指南发布后。女性和不同种族群体的测试率相似，并且正如预期的那样，老年群体和社会贫困群体的 NP 测试较多。心力衰竭检出率在研究期间保持稳定（约 10%），诊断前未进行 NP 检测的患者比例仍然很高 [2004 年为 99.6% (n = 13 484)，而 2004 年为 76.7% (n = 12 978)。 2017]。结论 初级保健中的 NP 检测随着时间的推移而增加，没有证据表明存在明显的不平等，但大多数心力衰竭患者在诊断前仍然没有记录 NP 检测。可能需要在初级保健中进行更多的 NP 检测，以防止住院并促进在更早、更容易治疗的阶段诊断心力衰竭。