Natriuretic peptide-guided management by the general practitioner: how to interpret the SIGNAL.

摘要

Chronic heart failure (CHF) remains a major public health problem worldwide, accounting for high numbers of hospitalizations and enormous costs. Primary care physicians usually manage and treat large numbers of CHF patients in an outpatient care setting and are also frequently the first to diagnose HF. Although substantial diagnostic and therapeutic progress has been achieved in recent years, there is still a high level of uncertainty in the diagnostic and therapeutic management of CHF patients. Recently, there has been increased interest in the use of biomarkers in HF; in particular, natriuretic peptides (NPs) as quantitative markers of cardiac stress could successfully be incorporated into cardiology practice. In fact numerous studies have convincingly shown that NPs have a very high diagnostic accuracy for acute HF in patients presenting with dyspnoea to the emergency department.1'2 Natriuretic peptides have also been evaluated for guiding HF therapy compared with conventional CHF therapy. However, previous studies have shown conflicting results.