37 Assessment of pro-BNP measurement during hospitalization according HSE National laboratory handbook
Year: 2023
Type: conference-abstract
Abstract: Background Heart failure (HF) diagnosis is not a single pathological diagnosis, but a clinical syndrome consisting of cardinal symptoms (e.g. breathlessness, ankle swelling, and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles, and peripheral oedema). Elevated plasma concentrations of the BNP support the diagnosis of acute HF, are useful for prognosis, and may guide further cardiac investigation. The objective of this study was to determine the appropriate testing of pro-BNP levels in inpatients in Sligo University Hospital in keeping with HSE national laboratory handbook and 2021 European Society Cardiology (ESC) guidelines. Methodology We completed a point prevalence of 36 adult inpatients in Sligo General Hospital in a prospective lab analysis, images and their respective chart review. Patient selections were based on pro-BNP analysis done on Mondays starting in January for a period of 8 weeks, until their time of discharge. The standard measured against was the National Laboratory Handbook – Laboratory Testing for Natriuretic Peptides (NP) – BNP/NT-proBNP (2021) and 2021 ESC Guideline for the diagnosis and treatment of acute and chronic heart failure. Results His study revealed that 50% of all pro-BNP measurements were inappropriately ordered by medical teams. The majority of inappropriate measurements were performed in cases of LRTI (n=14). Additionally, the second most common offender of inappropriate testing constituted repeat measurements, with 70% of this cohort having ≥ 3 measurements performed. In March 2023 at SGH, a total of €19650 in expenditure was utilised on reagents for the pro-BNP assay, accounting for 16% of the blood science reagent expenditure, thereby representing a vastly disproportionate cost compared to the rest of routine labs. Other reasons for inappropriate pro-BNP measurements included patients with atrial fibrillation (n=3), asthma (n=1), spinal cord compression (n=1) and non-ST elevation myocardial infarction. Pro-BNP data in high prevalence wards were noticed, as the Coronary Care Unit and Emergency Department with 24% of the measurements, followed by Acute Assessment Unit with 18% and Short Stay Unit with 8% of analysis requested. Conclusion The decision to measure pro-BNP level is most useful to support a diagnosis of heart failure and when there is any uncertainty in diagnosis. It is important to keep in consideration the fact of pro-BNP measurement has a high negative predictive value with low specificity. Therefore, the appropriate use and interpretation of NPs in the investigation of patients presenting with suspected acute HF is crucial. Results The following graphic (figure 1) shows the number of patients where pro-BNP measurement was done adequately according to the National Laboratory Handbook – Laboratory Testing for Natriuretic Peptides (NP) – BNP/NT-proBNP (2021). figure 2 represents the number of patients with the clinical indication where pro-BNP was measured inappropriately: Furthermore, in relation to the percentage where repeat analysis was done, it was possible to observe that 7 (70%) patients had ≥ 3 measurements done while in the hospital. The following table (table 1) shows the percentages of patients‘ pro-BNP measurements according to their location was made:
Source: Heart
Authors: J Castro Carvalho, A Hodgson, A Fathima, J Ramjohn, L Wrotniak, S Riaz
Institution: Sligo University Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4387541531