Does serum B type natriuretic peptide (BNP or NT-pro BNP) testing and monitoring in patients with heart failure benfit patients and the NHS
However, we expect it to be difficult to conclude that the overall finding from these trials should be applied to the general population with heart failure, whether managed by their GPs or hospital doctors, since the patients participating in clinical trials are not representative of the general population with heart failure – they are younger, with more men than women, having only a certain type of heart failure (reduced ventricular ejection fraction) and no other conditions. Also, most trials have been conducted outside the UK, making it difficult to determine whether measuring BNP is cost effective in the UK setting.
Therefore, we propose to supplement the IPD meta-analysis with analyses of a representative group of patients with heart failure in the UK (STUDY 2). We will create this patient group by linking data from the Clinical Practice Research Database (CPRD, which contains patient data from GP practices) and the UK National Heart Failure Audit (NHFA, which contains data on patients admitted to hospital with heart failure), as well as hospital record data and death registry data. These data will allow us to profile how heart failure patients are cared for in the NHS, from diagnosis, through treatment, to outcome. Both databases have a subset of patients who have had BNP values recorded. We propose to match these patients with a similar group of patients who have not had a BNP value recorded (taken from the same databases). We will compare groups with and without BNP measurements for differences in risk of death, hospital admission/readmission and length of hospital stay (for those admitted to hospital), prescribed medications, number of outpatient appointments and patient management. We will also undertake a health economic analysis to determine whether measuring BNP is cost effective in the NHS (STUDY 3).