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Family Practice Advance Access originally published online on December 3, 2008
Family Practice 2009 26(1):69-74; doi:10.1093/fampra/cmn096
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© The Author 2008. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Clinically relevant diagnostic research in primary care: the example of B-type natriuretic peptides in the detection of heart failure

Johannes C Keldera,b, Frans H Ruttena and Arno W Hoesa

a Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, Stratenum 6.131, 3508 GA Utrecht
b Department of Cardiology, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands

Correspondence to Frans H Rutten, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, Stratenum 6.131, 3508 GA Utrecht, The Netherlands; Email: f.h.rutten{at}umcutrecht.nl

Received 6 June 2008; Revised 23 October 2008; Accepted 11 November 2008.


  Abstract

With the emergence of novel diagnostic tests, e.g. point-of-care tests, clinically relevant empirical evidence is needed to assess whether such a test should be used in daily practice. With the example of the value of B-type natriuretic peptides (BNP) in the diagnostic assessment of suspected heart failure, we will discuss the major methodological issues crucial in diagnostic research; most notably the choice of the study population and the data analysis with a multivariable approach. BNP have been studied extensively in the emergency care setting, and also several studies in the primary care are available. The usefulness of this test when applied in combination with other readily available tests is still not adequately addressed in the relevant patient domain, i.e. those who are clinically suspected of heart failure by their GP. Future diagnostic research in primary care should be targeted much more at answering the clinically relevant question ‘Is it useful to add this (new) test to the other tests I usually perform, including history taking and physical examination, in patients I suspect of having a certain disease’.

Keywords. Diagnosis, primary care, heart failure, B-type naturiuretic peptide.

Kelder JC, Rutten FH and Hoes AW. Clinically relevant diagnostic research in primary care: the example of B-type natriuretic peptides in the detection of heart failure. Family Practice 2009; 26: 69–74.


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E-letters:

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BNP example misses the most clinically relevant points.
Ben Ewald, et al.
Family Practice, 8 Dec 2008 [Full text]
Review missed the most clinically relevant diagnostic research of all.
Ben d Ewald
Family Practice, 10 Feb 2009 [Full text]
RCT design is usually not the best option in diagnostic research
Frans H Rutten, et al.
Family Practice, 13 Feb 2009 [Full text]

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