Relations between medical history, clinical findings and plasma N-terminalproatrial natriuretic peptide in patients in primary health care

Background: recent studies indicate that measurement of natriuretic peptide s may be a valuable tool to improve the quality of the diagnosis of heart f ailure in general practice. Aim: the aim of the present study was to examin e the relationship between the plasma level of the natriuretic peptide N-te rminal proANP and symptoms and signs of heart failure in patients from gene ral practice in the Oslo area. Methods and Results: we undertook a survey o f 499 patients consecutively enrolled from the practice of 27 practitioners . One hundred and twenty-nine patients were classified as having possible o r some degree of heart failure. The plasma concentration of N-terminal proA NP increased with severity of heart failure as judged from clinical examina tion. In multivariate analysis age, history of heart disease, plasma creati nine, use of beta-blockers and digitalis, oedemas and atrial fibrillation w ere the main determinants of plasma N-terminal proANP. Conclusion: while th ere was an overall increase in N-terminal proANP values with increasing sym ptoms and degree of heart failure, no single finding was closely related to N-terminal proANP. Treatment effects and diagnostic errors may both influe nce the relationship between N-terminal proANP and clinical findings. The c urrent study has demonstrated the feasibility of using N-terminal proANP by general practitioners for the potentially improved diagnosis of heart fail ure. Further research is required to determine the precise role of this ass ay in clinical practice. (C) 2001 European Society of Cardiology. All right s reserved.