{
  "abstract": "Introduction N-terminal-pro hormone of Brain Natriuretic Peptide (NT-proBNP) is a sensitive rule-out test for new-onset acute heart failure (HF) with a high negative predictive value. However, it is not specific and can be influenced by various factors including cardiac (e.g. ACS, arrhythmia) and non-cardiac (advancing age and co-morbidities such as chronic kidney disease and anaemia). These factors must be taken into account when utilising NT-proBNP as a screening tool.Due to the high demand on echocardiography services, the British Society of Echocardiography (BSE) have recommended a triage criteria for inpatient echocardiography requests, including an age-specific NT-proBNP concentration cut-off for those with suspected HF.Our aim was to evaluate the effectiveness and safety of using these BSE recommendations for the inpatient diagnosis of HF when triaging echocardiography requests, and their potential impact on the inpatient demand for echocardiography.Method We retrospectively analysed and compared NT-proBNP results and inpatient echocardiogram findings reported between 1 st and 15th March 2024 at two centres in the East of England. Patients were divided into the three BSE NT-proBNP cut-off levels: ≥ 450 ng/l in those under 50 years of age, ≥ 900 ng/l for those between 50 and 75 years of age (inclusive), and ≥ 1800 ng/l for those over 75 years of age, for comparison.Results 159 patient records were analysed to determine if their NT-proBNP concentration met the BSE criteria to trigger an inpatient echocardiogram. The mean age was 80±13.04 years. 47.8% (76) were women. 100 (62.9%) patients had an NT-proBNP concentration that met the BSE criteria. 65 (65%) of these had an inpatient echocardiogram. Of the remaining 59 (37.1%) who did not meet the criteria, 49.2% (29) had an echocardiogram.Of those who met the criteria and had an echocardiogram, 39 (60%) were diagnosed with HF. Of those who did not meet the criteria and had an echocardiogram, 9 (30.4%) were diagnosed with HF.Abstract 5-018 Table 1Results summary Number of Patients Met BSE criteria for inpatient TTE (n=100) Did not meet BSE criteria for inpatient TTE (n=59) P value Had Echo 65 (65%) 29 (49.2%) Positive HF Diagnosis 39 (60%) 9 (30.4%) 0.014 Numbers (%)A review of these nine cases found that in 7 there were valid reasons other than elevated NT-proBNP for these requests, including strong clinical suspicion of HF based on clinical presentation, new acute coronary syndrome presentation and ventricular tachycardia. Allowances in the BSE criteria mean that these patients would still have qualified for an inpatient echocardiogram despite a below-threshold NT-proBNP. In two patients with a reportedly abnormal echocardiogram, a subsequent cardiac MRI was normal. No cases of HF were, therefore, truly missed.Abstract 5-018 Table 2Diagnosis after review of the nine cases who would not have met BSE age-specific NT-proBNP criteria Number of patients Reasons 3 Known HF on treatment 2 Subsequent inpatient Cardiac MRI was normal 1 Duplicate patient 1 Acute Coronary Syndrome 1 New diagnosis of HF with clinical presentation highly suggestive of HF 1 Ventricular Tachycardia Conclusions With a sensitivity and specificity of 81% and 43% respectively, our data suggests that the BSE’s age-related NT-proBNP criteria for inpatient echocardiography provides a safe and viable framework for triaging inpatient requests towards a diagnosis of HF. This approach could reduce the burden on over stretched services, allowing resources to be directed more appropriately.",
  "authors": [
    {
      "affiliations": [
        "Mid and South Essex NHS Foundation Trust"
      ],
      "name": "Andrew Madu"
    },
    {
      "affiliations": [
        "Mid and South Essex NHS Foundation Trust",
        "Clinical Research Fellow, Anglia Ruskin University"
      ],
      "name": "Brian Li"
    },
    {
      "affiliations": [
        "Mid and South Essex NHS Foundation Trust"
      ],
      "name": "Daniela Toumazi"
    },
    {
      "affiliations": [
        "Mid and South Essex NHS Foundation Trust"
      ],
      "name": "Muhammad Asad"
    },
    {
      "affiliations": [
        "Mid and South Essex NHS Foundation Trust"
      ],
      "name": "Aryan Sabir"
    },
    {
      "affiliations": [
        "Mid and South Essex NHS Foundation Trust"
      ],
      "name": "Duncan Coles"
    },
    {
      "affiliations": [
        "Mid and South Essex NHS Foundation Trust",
        "Visiting Associate Professor, Anglia Ruskin University"
      ],
      "name": "Henry Savage"
    },
    {
      "affiliations": [
        "Mid and South Essex NHS Foundation Trust"
      ],
      "name": "Anthony Dimarco"
    }
  ],
  "title": "5-018 Retrospective implementation of BSE age-specific NT-proBNP criteria for triage of inpatients with potential heart failure",
  "uid": "00e8804a-ca78-5241-8341-f61dc5a12347"
}