But you only get one NT-proBNP per patient per year.
The NT-proBNP blood test to help diagnose heart failure will from today (Friday 1 November) be covered by Medicare, though the test can only be done once per patient per year.
Cardiologist Professor Andrew Sindone, who was involved in efforts to secure funding, said patients would save around $80 on the NT-proBNP test, which was previously only covered if ordered in emergency departments. It would especially benefit patients with limited access to echocardiograms, such as those in rural and regional areas.
The federal government rejected a request for Medicare coverage in 2011 citing lack of data and cost.
Reversing that decision took an odyssey of consultations with ministers and subcommittees of the MSAC, which finally approved it a year ago, persuaded it would save the government paying for unnecessary echocardiograms. The government funded it in the May budget but delayed the implementation until now.
The test is for exclusion, rather than confirmation. N-terminal pro B-type natriuretic peptide is elevated when the heart is under stress. Low NT-proBNP can exclude heart failure, while a high count requires further investigation.
“In an ambulatory person with shortness of breath, if the NT-proBNP is less than 125 then it’s not heart failure,” Professor Sindone told TMR. “But if it’s high, if it’s over 300, it might be heart failure. Other things can cause it to go up, like renal failure, sepsis, pulmonary embolism or very severe lung disease.
“It’s a good way of triaging people and making sure they get the right care early, and avoids unnecessary tests like an echocardiogram if they don’t need it.
“If they don’t have heart failure, they don’t have to go to the cardiologist. If they do, we have treatments that can reduce death and hospitalisation.
In other places such as the UK, NT-proBNP is a gatekeeper test before a patient is allowed to get an echocardiogram.
Professor Sindone said that of the wide range of possible causes of shortness of breath, heart failure was probably the most lethal.
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“Heart failure has a worse prognosis than most cancers,” he said. “Fifty per cent of people will be dead within five years. If someone has stage three bowel cancer you don’t tell them to come back in three months and see how they’re feeling. You start them on treatment straight away, and that’s what we should be doing with heart failure as well.
“We can now diagnose people with heart failure with reduced or preserved ejection fraction, give them the right treatment, get them on the right pathway and do our three jobs: make them feel better, make them live longer and keep them out of hospital.”
Professor Sindone was involved in the SHAPE study, which sought to estimate the prevalence of heart failure in Australia using primary care data. He said the estimate of around 580,000 with reduced ejection fraction (HFrEF), and up to a million including those with preserved ejection fraction (HFpEF), was “scary” and a lot higher than anticipated.
Those with HFpEF are more likely to be older and female, with high blood pressure, atrial fibrillation and/or diabetes. HFrEF is more common in people with a previous heart attack, valvular heart disease or who’ve had chemotherapy or have a familial condition.
The STRONG-HF study published in 2022 found that heart failure treatment (with beta blockers, ARNIs, MRAs and SGLT2 inhibitors) guided by repeat NT-proBNP testing could reduce heart failure mortality and hospital readmission by one-third.
… But that’s an MSAC campaign for another day.
