PT - JOURNAL ARTICLE AU - Morton, Geraint AU - Philip, Legate AU - Gilpin, Thomas AU - Chan, Pik Ee AU - Guha, Kaushik AU - Kalra, Paul R TI - Does specialist review for patients with suspected heart failure predict better outcomes? An observational study on the utility of compliance with NICE guidelines AID - 10.1136/bmjopen-2018-021856 DP - 2018 Aug 01 TA - BMJ Open PG - e021856 VI - 8 IP - 8 4099 - http://bmjopen.bmj.com/content/8/8/e021856.short 4100 - http://bmjopen.bmj.com/content/8/8/e021856.full SO - BMJ Open2018 Aug 01; 8 AB - Objectives Compare outcomes in patients with suspected heart failure (HF) and raised natriuretic peptides who are reviewed in a specialist HF clinic in line with National Institute for Health and Care Excellence (NICE) guidelines (compliant group) versus patients who are not reviewed in the clinic (non-compliant group).Design Retrospective observational study.Setting Single large UK district general hospital.Participants 567 consecutive patients in primary care with raised N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels (>400 pg/mL) from February to September 2014.Interventions 161 (28%) patients were referred to the specialist HF clinic and 406 (72%) were not. Outcomes were compared between the two groups.Outcome measures All-cause and cardiovascular (CV) hospitalisations and all-cause mortality.Results The compliant group were slightly younger than the non-compliant group (78±9 vs 80±9; p=0.019) but had much higher NT-pro-BNP (3108±4526 vs 2271±3637 pg/mL; p<0.0001). Despite this, over a mean follow-up period of 9±2 months, rates of all-cause hospitalisation (24% vs 44%; p<0.0001) and CV hospitalisation (3% vs 15%, p<0.0001) were significantly lower in the compliant group versus the non-compliant group, respectively. There was no significant difference in mortality rates (6% compliant group vs 8% non-compliant group; p=0.487).Conclusions Hospitalisation rates in patients with suspected HF and raised NT-pro-BNP were extremely high over a relatively short follow-up period. Patients reviewed in a specialist HF clinic had much higher NT-pro-BNP levels, suggesting they were at higher risk of adverse outcomes, yet also had significantly lower rates of all-cause and CV hospitalisation. Our findings support implementation of the relevant NICE guidelines for patients with suspected HF.