Can brain natriuretic peptide (BNP) be used as a screening tool in general practice?

Objective - To investigate plasma brain natriuretic peptide (p-BNP) in consecutive primary care patients for heart failure screening. Design - Open, descriptive. Setting - Three primary care clinics, university hospital. Subjects - 291 consecutive patients, greater than or equal to40 years. Main outcome measures - p-BNP and general practitioners estimated probability of chronic heart failure (CHF). Results - Median p-BNP was 29 ng/L. In 42% p-BNP was >40 ng/L in the first sample. In 41 patients further investigated, median p-BNP was 98 ng/L, with a correlation between p-BNP and physicians' estimation of probability of heart failure (r = 0.469, p < 0.0001). New York Heart Association class was correlated to p-BNP (r = 0.343, p = 0.034). No correlation between ejection fraction and p-BNP was seen. Conclusion - P-BNP concentrations in unselected primary care patients of 40 years of age or above were elevated in a larger proportion of patients than previously reported. Owing to the low specificity, p-BNP concentration limits have to be defined before the test can be used for screening in primary care.