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Our GPs have access to our NTproBNP service. We have a Direct Access local tariff and charge the PCT. I am working with our PCT to demand manage the requests and the NICE algorithm seems sensible. regards martin P.S. NICE cut-offs differ from recently published data (as posted on the mailbase by Paul Collinson on 17th September:- Hildebrandt P, Collinson PO, Doughty RN, Fuat A, Gaze DC, Gustafsson F et al. Age-dependent values of N-terminal pro-B-type natriuretic peptide are superior to a single cut-point for ruling out suspected systolic dysfunction in primary care. European Heart Journal (2010) 31, 1881-1889). in summary: NICE: Normal: NTproBNP <400pg/mL: "HF unlikely" Raised: NTproBNP 400-2000 pg/mL "Specialist assessment and echo within 6 weeks" High: NTproBNP>2000 pg/mL "Specialist assessment and echo within 2 weeks" Non-HF causes of high NP: LVH, ischaemia, tachycardia, RV overload, hypoxaemia (including pulmonary embolism), renal dysfunction (GFR<60 ml/min), sepsis, COPD, diabetes, age >70 years, cirrhosis of the liver. Hildebrandt et al 2010: show that a cut off at 400 ng/L gives a sensitivity of about 75% and recommend: <50 years (50 ng/L): 50-75 years (75 ng/L) >75 years (250 ng/L): ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Lang Tim (RXP) Consultant Biochemist Sent: 24 September 2010 09:05 To: [log in to unmask] Subject: Availability of BNP or NT-BNP Dear All, There is a short letter in today's BMJ concerning access to BNP/NT-BNP : NICE on chronic heart failure: What about access to investigations? : BMJ 2010; 341:c5010 How available are these assays to GPs and are they appropriately funded? Kind regards Tim Dr Tim Lang FRCPath Consultant Clinical Scientist Clinical Biochemistry Department University Hospital of North Durham North Road Durham DH1 5TW 0191 333 2694 0191 333 2115 (Fax) [log in to unmask] <mailto:[log in to unmask]> ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ This message and any files transmitted with it are confidential and intended solely for the individual(s) addressed. If you have received this e-mail in error then please note that disclosing, copying, distributing or retaining this message or any part of it is strictly prohibited. Please notify the sender immediately and delete it from your system. Any views or opinions presented are solely those of the author and do not necessarily represent those of Lancashire Teaching Hospitals NHS Foundation Trust. The Trust accepts no liability for any damage caused by any virus transmitted with this e-mail, so although it has been virus checked before transmission, the recipient should also check for the presence of viruses. The information contained in this email may be subject to public disclosure under the NHS Code of Openness or the Freedom of Information Act 2000. Unless the information is legally exempt from disclosure, the confidentiality of this email and any subsequent reply cannot be guaranteed. http://www.lancsteachinghospitals.nhs.uk ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/