BMJ  2003;327:932 (18 October), doi:10.1136/bmj.327.7420.932-b

Letter

What happened to evidence in NICE guidance on heart failure?

The first 150 words of the full text of this article appear below.

EDITOR—Recent guidelines from the National Institute for Clinical Excellence (NICE) on heart failure recommend measuring natriuretic peptide concentration in patients with suspected heart failure, in addition to electrocardiography to exclude heart failure.^{1 2} However, normal results on electrocardiography and chest radiography make heart failure highly unlikely.

Low concentrations of natriuretic peptides also make the diagnosis of heart failure unlikely, and what is gained in addition to the information from a normal electrocardiogram, which has a negative predictive value ranging from 77% to 97% depending on the cut-off point and background risk, is unclear. Even if the natriuretic peptide increased negative predictive value from 97%³ to 100%, is a 3% increase worth the additional cost and would it improve management?

A study of referrals of patients with symptoms also casts doubt on the advantages of natriuretic peptide testing, as does a study after myocardial infarction.⁴ In people who have an . . . [Full text of this article]

Department of General Practice, Queen Mary University of London, London E1 4NS jrobson@qmul.ac.uk

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