Aims N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been shown to be useful for ruling out heart failure in primary care. In this study, we examined the accuracy of the Cobas h232 point-of-care (POC) instrument in primary care compared with an in-hospital measurement. Furthermore, we investigated the user-friendliness and usefulness of the POC device.
Methods Five general practitioner (GP) groups were asked to evaluate adult patients who were suspected of having heart failure and to test NT-proBNP with the Cobas h232. The samples were subsequently delivered to and analysed at a central hospital laboratory by the Cobas e602 using conventional transport and storage. Difference between the paired measurements was analysed using a percentage difference plot, and correlation was assessed using Passing-Bablok linear regression analysis. User-friendliness and usefulness were assessed using semistructured questionnaires.
Results Nineteen GPs studied 94 patients. Passing-Bablok analysis showed a slope of 1.05 (95% CI 1.00 to 1.11) (R2=0.97). The percentage difference plot showed a mean difference of 15.7% (95% CI −46.0% to –77.4%). User-friendliness and usefulness had median scores of 4 or 5 on a five-point Likert scale. Eighteen out of 19 GPs confirmed that the device influenced their clinical practice. During the study, GPs’ confidence in using NT-proBNP increased significantly from a mean score of 4.4 (95% CI 3.2 to 5.6) to 7.6 out of 10 (95% CI 7.1 to 8.2).
Conclusions The Cobas h232 NT-proBNP POC test proved to be an accurate, user-friendly and useful test in primary care. Nearly all participating GPs were convinced that the test could benefit clinical decision making.
- poc testing
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Handling editor Tahir S Pillay.
Contributors CH, MS and BV designed the study and BV was responsible for the conduct of the study. JP was responsible for the laboratory analyses. CH and JV performed the statistical analyses. CH, JV and BV drafted the manuscript. All authors participated in the critical revision of the manuscript. All authors read and approved the final version of the manuscript.
Competing interests The Department of Public Health and Primary Care, KU Leuven designed and initiated the study. Roche Diagnostics had no role in the study design or initiation. Roche Diagnostics provided material support, in particular 5 Cobas h232 point-of-care instruments. The cost of the material, transportation and analysis was borne by Roche Diagnostics. The authors declare to have had full independence during data analysis, without interference by Roche. We hereby state the independence of researchers from funders.
Patient consent Obtained.
Ethics approval The ethics review board of the University Hospitals/KU Leuven, Belgium approved the study (reference mp11149).
Provenance and peer review Not commissioned; externally peer reviewed.
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