Quality statement 1: Single measurement of natriuretic peptide

Quality statement

Adults presenting to hospital with new suspected acute heart failure have a single measurement of natriuretic peptide.

Rationale

Natriuretic peptide testing (B‑type natriuretic peptide [BNP] or N‑terminal pro‑B‑type natriuretic peptide [NT‑proBNP]) is an important tool for rapidly assessing adults presenting to hospital with new suspected acute heart failure. It can be used to rule out a diagnosis of heart failure or to see if further investigation with echocardiography is needed. It can save time and distress for the adult presenting with new suspected acute heart failure.

Quality measures

Structure

Evidence of local arrangements to ensure that adults presenting to hospital with new suspected acute heart failure have a single measurement of natriuretic peptide.

Data source: Local data collection.

Process

a) Proportion of adults presenting to hospital with new suspected acute heart failure who have a single measurement of natriuretic peptide.

Numerator – the number in the denominator who have a single measurement of natriuretic peptide.

Denominator – the number of presentations of adults to hospital with new suspected acute heart failure.

Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012–2013.

b) Proportion of hospitals that use appropriate assay thresholds of plasma BNP less than 100 ng/litre and plasma NT‑proBNP less than 300 ng/litre.

Numerator – the number in the denominator that use appropriate assay thresholds of plasma BNP less than 100 ng/litre and plasma NT‑proBNP less than 300 ng/litre.

Denominator – the number of hospitals in England to which people may present with suspected acute heart failure.

Data source: Local data collection.

Outcome

a) Mortality rates.

Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012–2013.

b) Length of stay.

Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012–2013.

c) Readmission rates.

Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012–2013.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (cardiac service providers) ensure that adults presenting to hospital with new suspected acute heart failure have a single measurement of natriuretic peptide that is undertaken by the cardiac team to rule out a diagnosis of heart failure. Also, hospitals in England to which people may present with suspected acute heart failure ensure they use appropriate assay thresholds of plasma BNP less than 100 ng/litre and plasma NT‑proBNP less than 300 ng/litre.

Healthcare professionals ensure that adults with new suspected acute heart failure have a single measurement of natriuretic peptide on presentation to hospital to rule out a diagnosis of heart failure.

Commissioners (clinical commissioning groups) ensure that adults with new suspected acute heart failure have a single measurement of natriuretic peptide on presentation to hospital to rule out a diagnosis of heart failure.

What the quality statement means for patients, service users and carers

Adults presenting at hospital with new suspected acute heart failure have their natriuretic peptide (also known as BNP or NT‑proBNP) level in their blood measured. This test is a quick way for doctors to find out whether the person is likely to have heart failure or if they need further assessment to see if their symptoms are caused by something else.

Source guidance

  • Acute heart failure (2014) NICE guideline CG187, recommendation 1.2.2 (key priority for implementation)

Definitions of terms used in this quality statement

Natriuretic peptide

A protein substance secreted by the wall of the heart when it is stretched or under increased pressure. It has several forms and its level can be raised in a number of conditions, including heart failure. A normal natriuretic peptide level means that heart failure is unlikely, and its measurement can be used to exclude a diagnosis of heart failure.

[Adapted from acute heart failure (NICE guideline CG187) full guideline]

Appropriate assay thresholds of plasma BNP to assist in ruling out the diagnosis of heart failure

  • Plasma BNP less than 100 ng/litre

  • Plasma NT‑proBNP less than 300 ng/litre.

[Adapted from acute heart failure (NICE guideline CG187) full guideline]