{
  "abstract": "Introduction NT-proBNP (N-terminal pro-B-type natriuretic peptide) is commonly used as a biomarker for initial diagnosis of heart failure, both in community and acute care settings. However, it is crucial to assess if the tests are being conducted when clinically necessary, or if they are contributing to unnecessary expenditures. It is well known that there can be several causes of rising NT-proBNP other than heart failure from advancing age to atrial fibrillation or severe infection. 1 The aim of this audit was to review the usage of pro-BNP testing within the acute, non-specialist care setting, and to determine the appropriateness of these tests. Given the cost of £9 per test, identifying and reducing unnecessary or inappropriate testing could lead to significant cost savings without compromising patient care.Methods The biochemistry department provided a list of every pro-BNP test sent from A&E, MSDEC and AMU over January to June 2024. A data collection proforma was developed after reviewing NICE guidance 2 to gather a dataset that would allow analysis of appropriate versus inappropriate testing. A total of 252 patients were randomly selected for a review of A&E documentation and scanned medical notes. Data was collated on the hospital trust’s secure audit management system.Results 252 tests were reviewed; the age range was 47–102 (mean 77) with a gender distribution of 36% male and 64% female. A suspected diagnosis of heart failure was documented in only 51% of tests performed. Of the total number of tests audited, 35% of the patients had an existing diagnosis of heart failure prior to testing, suggesting at minimum, 88 tests were inappropriate with a cost of £792. Alternate causes for raised pro-BNP were highly prevalent amongst the patient cohort; severe infection including pneumonia or sepsis (20%), atrial fibrillation (42%), chronic obstructive pulmonary disease (COPD) (29%) and eGFR <60 (23%). 22% of the patients who underwent pro-BNP testing subsequently received an inpatient echocardiogram (n. 55). 21 of these echocardiograms were deemed inappropriate costing £2520 (£120 per echo). On review of all NT-proBNP tests performed within 6 months, 10% (n. 164) were duplicates, incurring a cost of £1476.Conclusion This audit has identified several areas for potential cost reduction. According to NICE guidance 2 pro-BNP monitoring in patients with existing heart failure should only be conducted in specialist settings, and only new presentations of acute heart failure should trigger pro-BNP testing3. Similarly repeat testing of undifferentiated patients in the acute setting is of limited value, as its primary role is in aiding the recognition of chronic heart failure.Further savings could be achieved by reducing testing in cohorts where elevated NT-proBNP levels are more likely due to alternative factors. Additional costs associated with elevated NT-proBNP testing include follow up echocardiogram and hospital bed days while awaiting investigations.References Theresa A McDonagh, Marco Metra, Marianna Adamo, Roy S Gardner, Andreas Baumbach, Michael Böhm, Haran Burri, Javed Butler, Jelena &Ccaron;elutkien&edot;, Ovidiu Chioncel, John GF Cleland, Andrew JS Coats, Maria G Crespo-Leiro, Dimitrios Farmakis, Martine Gilard, Stephane Heymans, Arno W Hoes, Tiny Jaarsma, Ewa A Jankowska, Mitja Lainscak, Carolyn SP Lam, Alexander R Lyon, John JV McMurray, Alexandre Mebazaa, Richard Mindham, Claudio Muneretto, Massimo Francesco Piepoli, Susanna Price, Giuseppe MC Rosano, Frank Ruschitzka, Anne Kathrine Skibelund, ESC Scientific Document Group, 2021. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal 2021;42(36):3599–3726. https://doi.org/10.1093/eurheartj/ehab368 Chronic heart failure in adults: diagnosis and management NICE guideline [NG106]Published: 12 September 2018.Acute heart failure: diagnosis and management Clinical guideline [CG187]Published: 08 October 2014.",
  "authors": [
    {
      "affiliations": [
        "Stepping Hill Hospital, Stockport, UK"
      ],
      "name": "Chloe Ablett"
    },
    {
      "affiliations": [
        "Stepping Hill Hospital, Stockport, UK"
      ],
      "name": "Matthew Luc Cronin"
    },
    {
      "affiliations": [
        "Stepping Hill Hospital, Stockport, UK"
      ],
      "name": "Jamie Alexander Broom"
    },
    {
      "affiliations": [
        "Stepping Hill Hospital, Stockport, UK"
      ],
      "name": "Maria Haider"
    },
    {
      "affiliations": [
        "Stepping Hill Hospital, Stockport, UK"
      ],
      "name": "Daniel Lewis Hodgin"
    },
    {
      "affiliations": [
        "Stepping Hill Hospital, Stockport, UK"
      ],
      "name": "David Lai Chin Kon"
    }
  ],
  "title": "5-001 Evaluation of NT-proBNP testing usage in the acute setting: are there cost savings to be made?",
  "uid": "79e75fd5-a9aa-520a-971e-a53537e03128"
}