An automated high-threshold NT-proBNP referral pathway (>5000 pg/mL) is feasible and identifies very high-risk patients, with enrolled patients experiencing rapid therapy optimisation and observed improvements in symptoms and cardiac function.
Over 12 months, 889 referrals were generated by the automated NT-proBNP pathway, distributed across multiple patient categories.
The median time to review for enrolled patients was 2 days, with 70% meeting the 48-hour target.
Enrolled patients were predominantly elderly with markedly elevated NT-proBNP levels at presentation.
HF with reduced ejection fraction (HFrEF) was the most common diagnosis among newly enrolled patients.
At 12 weeks, 62% of enrolled patients had improved by at least one New York Heart Association (NYHA) functional class.
Mean left ventricular ejection fraction (LVEF) increased substantially from 27% to 45% at 12 weeks in patients with HFrEF.
At 12 weeks, admission and mortality rates in enrolled patients were 36% and 8%, respectively, compared with 35% and 12% in the retrospective comparator cohort.
The automated pathway triggered referrals for all outpatient NT-proBNP results exceeding 5000 pg/mL, embedded within electronic patient records.
This research describes a new automated system designed to quickly identify and treat patients with very high levels of NT-proBNP, a blood marker that signals stress on the heart. When a patient's NT-proBNP result exceeded 5,000 pg/mL, the electronic health record system automatically sent a referral to the heart failure (HF) specialist team. Over 12 months, this generated 889 referrals. Of these, 43 patients were newly diagnosed outpatients without a prior HF diagnosis who were enrolled in the rapid-assessment pathway, receiving an echocardiogram (heart ultrasound) and specialist review within 48 hours in most cases. Among these newly enrolled patients, who were mostly in their 80s with very high biomarker levels, nearly half were found to have HF with severely reduced heart pumping function (HFrEF). After rapid treatment, the results were notable: 62% of patients felt significantly better at 12 weeks (improving by at least one NYHA functional class), and in those with HFrEF, average heart pumping function nearly doubled — from 27% to 45%. Compared to a historical group of similar patients seen before the pathway existed, mortality at 12 weeks was numerically lower (8% vs 12%), although the study was not large enough to confirm this statistically. This research suggests that embedding an automated high-threshold NT-proBNP alert directly into electronic patient records is a practical and potentially impactful way to fast-track vulnerable heart failure patients to specialist care. The findings indicate that rapid diagnosis and treatment can lead to meaningful improvements in both symptoms and heart function in a very high-risk elderly population, and may help reduce delays that could contribute to worse outcomes.
Henry J, Brown C, Almeida C, Devin J, Jones T, Vidal M, et al.. (2026). Feasibility and outcomes of an automated high-alert NT-proBNP pathway.. Open heart. https://doi.org/10.1136/openhrt-2026-004325