Diagnostic accuracy of point-of-care natriuretic peptide testing for chronic heart failure in ambulatory care: a systematic review and meta-analysis
Taylor KS., Verbakel JY., Feakins BG., Price CP., Perera R., Bankhead C., Pluddemann A.
Objectives To assess the diagnostic accuracy of point-of-care natriuretic peptide tests in patients with chronic heart failure, with a particular focus on the ambulatory care setting. Design Systematic review and diagnostic meta-analysis. Data sources Ovid MEDLINE, the Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Embase, Health Technology Assessment, Science Citation Index and Conference Proceedings Citation Index until 31 March 2017. Study selection Eligible studies evaluated point-of-care natriuretic peptide testing (B type natriuretic peptide [BNP] or N-terminal pro-brain natriuretic peptide [NT-proBNP]) against any relevant reference standard, including laboratory-based tests, echocardiography, clinical examination or combinations of these, in humans. Studies were excluded if insufficient data was reported to construct 2x2 tables. No language restrictions were applied. Results 42 publications of 39 individual studies met our inclusion criteria and 40 publications of 37 studies were included in our analysis. Of these 37 studies, 30 evaluated BNP point-of-care testing, and 7 evaluated NT-proBNP testing. Fifteen studies were carried out in ambulatory care settings with low prevalence populations. Five studies were undertaken in primary care. At thresholds >100 pg/mL sensitivity of BNP, measured with the Triage, was generally high and 0.95 (95% CI 0.90 to 0.98) at 100 pg/mL. At lower thresholds of <100 pg/mL, sensitivity ranged from 0.46 to 0.97, and specificity ranged from 0.31 to 0.98. Primary care studies of NT-proBNP testing reported sensitivity 0.99 (95% CI 0.57 to 1.00) and specificity 0.60 (95% CI 0.44 to 0.74) at 135 pg/mL. There was no statistically significant difference in diagnostic accuracy between point-of-care BNP and NT-proBNP tests. Conclusions Given the general lack of studies performed in primary care, the paucity of NT-proBNP data and potential methodological limitations in these studies, there is a need for large-scale trials in primary care, to assess the role of point-of-care natriuretic peptide testing and clarify appropriate thresholds to improve care of patients with suspected or chronic heart failure.