Effectiveness and cost-effectiveness of a virtual community of practice to improve the empowerment of patients with ischaemic heart disease: study protocol of a randomised controlled trial.

INTRODUCTION: Virtual Communities of Practice (VCoP) or knowledge-sharing virtual communities offer ubiquitous access to information and exchange possibilities for people in similar situations, which might be especially valuable for the self-management of patients with chronic diseases. In view of the scarce evidence on the clinical and economic impact of these interventions on chronic conditions, we aim to evaluate the effectiveness and cost-effectiveness of a VCoP in the improvement of the activation and other patient empowerment measures in patients with ischaemic heart disease (IHD). METHODS AND ANALYSIS: A pragmatic randomised controlled trial will be performed in Catalonia, Madrid and Canary Islands, Spain. Two hundred and fifty patients with a recent diagnosis of IHD attending the participating centres will be selected and randomised to the intervention or control group. The intervention group will be offered participation for 12 months in a VCoP based on a gamified web 2.0 platform where there is interaction with other patients and a multidisciplinary professional team. Intervention and control groups will receive usual care. The primary outcome will be measured with the Patient Activation Measure questionnaire at baseline, 6, 12 and 18 months. Secondary outcomes will include: clinical variables; knowledge (Questionnaire of Cardiovascular Risk Factors), attitudes (Self-efficacy Managing Chronic Disease Scale), adherence to the Mediterranean diet (Mediterranean Diet Questionnaire), level of physical activity (International Physical Activity Questionnaire), depression (Patient Health Questionnaire), anxiety (Hospital Anxiety Scale-A), medication adherence (Adherence to Refill Medication Scale), quality of life (EQ-5D-5L) and health resources use. Data will be collected from self-reported questionnaires and electronic medical records. ETHICS AND DISSEMINATION: The trial was approved by Clinical Research Ethics Committee of Gregorio Marañón University Hospital in Madrid, Nuestra Señora de Candelaria University Hospital in Santa Cruz de Tenerife and IDIAP Jordi Gol in Barcelona. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, local/international conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03959631). Pre-results.

Utilidad y fiabilidad de la ecografía clínica en medicina familiar: ecografía del cuello y ecografía en urgencias / Usefulness and reliability of point of care ultrasound in Family Medicine: Focused ultrasound in neck and emergency

La ecografía es una herramienta de gran valor para el diagnóstico y el manejo de una gran variedad de situaciones clínicas cotidianas. El médico de familia como especialista generalista debe ser competente para el abordaje de prácticamente cualquier problema de salud que afecte a su población, por lo que, en sus manos, esta herramienta puede proporcionar un elevado impacto sobre la calidad y la eficacia del proceso asistencial. Este es el último artículo de una serie dedicada a mostrar la aplicabilidad de la ecografía clínica en nuestras manos, en la que hemos revisado la mayoría de sus aplicaciones, como la ecografía clínica abdominal, la nefrourológica, la musculoesquelética, la cardiaca o la pulmonar. Queremos terminar con escenarios como la afección del cuello o su uso en situaciones de urgencia, en las que proporciona datos definitivos para la orientación diagnóstica, el manejo clínico e incluso la supervivencia del paciente, tales como el paciente con sospecha de trombosis venosa profunda en miembros inferiores, traumatismo toracoabdominal, compromiso hemodinámico o parada cardiaca

Ultrasound is a very useful tool for diagnosis and to handle a great sort of daily affaires. The family Doctor, as general specialist, must be competent to carry out almost all kind of wealthy situations that can potentially affect to his population. Because of that, with this tool in his hand, the Doctor can get a higher level of quality in the efficiency of the assistant procedure. This is the last paper of a serial dedicated to show the different applications of clinical ultrasound, in which most of them have been reviewed, such as abdominal, nephrourological, musculoskeletal, cardiac or pulmonary focused ultrasound. We want to finalize with scenarios like neck pathology or applications in urgencies in which we can provide the definitive data to get the right diagnosis orientation, the clinic use, or even patient live, such as the patient under deep vein thrombosis in lower members, thoracoabdominal trauma, hemodynamic compromise situation or cardiac arrest

[Usefulness and reliability of point of care ultrasound in Family Medicine: Focused ultrasound in neck and emergency]. / Utilidad y fiabilidad de la ecografía clínica en medicina familiar: ecografía del cuello y ecografía en urgencias.

Ultrasound is a very useful tool for diagnosis and to handle a great sort of daily affaires. The family Doctor, as general specialist, must be competent to carry out almost all kind of wealthy situations that can potentially affect to his population. Because of that, with this tool in his hand, the Doctor can get a higher level of quality in the efficiency of the assistant procedure. This is the last paper of a serial dedicated to show the different applications of clinical ultrasound, in which most of them have been reviewed, such as abdominal, nephrourological, musculoskeletal, cardiac or pulmonary focused ultrasound. We want to finalize with scenarios like neck pathology or applications in urgencies in which we can provide the definitive data to get the right diagnosis orientation, the clinic use, or even patient live, such as the patient under deep vein thrombosis in lower members, thoracoabdominal trauma, hemodynamic compromise situation or cardiac arrest.

Utilidad y fiabilidad de la ecografía clínica en Medicina Familiar: ecocardioscopia y ecografía pulmonar / Usefulness and reliability of point of care ultrasound in Family Medicine: Focused cardiac and lung ultrasound

El médico de familia está incorporando la ecografía clínica como técnica de exploración y diagnóstico en su actividad asistencial, del mismo modo que el resto de los especialistas. Su papel generalista lo convierte en un potencial utilizador de todas las posibles aplicaciones de esta técnica, lo cual puede causar un elevado impacto en su capacidad de manejar, enfocar y resolver un gran número de situaciones clínicas. En este artículo nos dedicamos a valorar la utilidad y la efectividad de la ecografía clínica por parte del médico de familia en sus aspectos más novedosos, como son la ecocardiografía clínica y la ecografía pulmonar

The family doctor incorporates clinical ultrasound as an exploration and diagnosis technique in his care activity, the same way as the rest of the specialists. His generalist role makes him a potential user of all possible applications of this technique, which can provide a high impact on his ability to manage, focus and solve a large number of clinical situations. In this article we focus on assessing the usefulness and reliability of clinical ultrasound performed by the family doctor in their most novel aspects such as focused cardiac ultrasound and lung ultrasound

[Usefulness and reliability of point of care ultrasound in Family Medicine: Focused cardiac and lung ultrasound]. / Utilidad y fiabilidad de la ecografía clínica en Medicina Familiar: ecocardioscopia y ecografía pulmonar.

The family doctor incorporates clinical ultrasound as an exploration and diagnosis technique in his care activity, the same way as the rest of the specialists. His generalist role makes him a potential user of all possible applications of this technique, which can provide a high impact on his ability to manage, focus and solve a large number of clinical situations. In this article we focus on assessing the usefulness and reliability of clinical ultrasound performed by the family doctor in their most novel aspects such as focused cardiac ultrasound and lung ultrasound.

Documento de consenso de SEMI, semFYC, SEN y SEC sobre ecocardioscopia en España / Consensus document of the SEMI, semFYC, SEN, and SEC on focused cardiac ultrasound in Spain

En el presente documento se sintetizan el concepto de ecocardioscopia, los aspectos técnicos fundamentales relacionados con esta técnica y sus objetivos diagnósticos. Además, se define cómo deben ser la formación y la capacitación en ecocardioscopia. Todo ello, avalado por la Sociedad Española de Medicina Interna (SEMI), la Sociedad Española de Medicina Familiar y Comunitaria (semFYC), la Sociedad Española de Neurología (SEN) y la Sociedad Española de Cardiología (SEC)

This document summarizes the concept of focused cardiac ultrasound, the basic technical aspects related to this technique, and its diagnostic objectives. It also defines training requisites in focused cardiac ultrasound. This consensus document has been endorsed by the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of Neurology (SEN), and the Spanish Society of Cardiology (SEC)

Consensus Document of the SEMI, semFYC, SEN, and SEC on Focused Cardiac Ultrasound in Spain.

This document summarizes the concept of focused cardiac ultrasound, the basic technical aspects related to this technique, and its diagnostic objectives. It also defines training requisites in focused cardiac ultrasound. This consensus document has been endorsed by the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of Neurology (SEN), and the Spanish Society of Cardiology (SEC).

[Atrial fibrillation: from detection to treatment. Role of the family physician, cardiologist and other specialists. New models of clinical management]. / Fibrilación auricular: de la detección al tratamiento. Papel del médico de familia, del cardiólogo y de otros especialistas. Nuevos modelos de gestión clínica.

The prevalence of atrial fibrillation (AF) in adults in Spain is estimated to be 4.4% of the population aged 40 years or more, corresponding to a mean of 30 to 40 patients per family physician. The importance of this common arrhythmia lies, above all, in its close association with stroke and other systemic embolisms, among other possible complications. Diagnosis of AF is based on electrocardiographic recording and can consequently be made by the family physician, who should make an overall assessment of the patient's health, including risk factors, comorbidity and type of AF and evaluate embolic and hemorrhagic risk. The decision to prescribe anticoagulation therapy or not should be taken promptly and should be based on the patient's embolic risk and not on the type of arrhythmia. In addition, the family physician, together with the treating cardiologist, should decide on the most appropriate therapeutic strategy for each individual patient: a rhythm control strategy (attempting to recover and maintain sinus rhythm) or a rate control strategy (maintaining heart rate within acceptable limits). Antithrombotic treatment should form part of both strategies, since stroke is the most serious and common complication of AF and also has the greatest effects on morbidity and mortality. Moreover, cardioembolic strokes (accounting for one out of every four strokes) are especially devastating, with the highest fatality, hospital and social resource use, and associated disability. Control of AF and particularly stroke prevention with adequate anticoagulation should be carried out mainly in primary care. Nevertheless, multidisciplinary management is required in most patients, which requires effective coordination between primary and specialized care, especially cardiology, hematology and neurology (in patients who have already had a stroke).

Los escenarios de utilidad de los péptidos natriuréticos. Respuesta de los autores / The use scenarios of the natriuretic peptides. Reply

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Fibrilación auricular: de la detección al tratamiento. Papel del médico de familia, del cardiólogo y de otros especialistas. Nuevos modelos de gestión clínica / Atrial fibrillation: from detection to treatment. Role of the family physician, cardiologist and other specialists. New models of clinical management

Se estima que la prevalencia en adultos de fibrilación auricular (FA) en España es del 4,4% de la población >40 años, lo que correspondería a una media de 30 a 40 pacientes por cada médico de familia. La importancia de esta frecuente arritmia radica, sobre todo, en su estrecha relación con el ictus u otras embolias sistémicas por delante de otras posibles complicaciones. El diagnóstico de FA es su registro electrocardiográfico, por lo que está al alcance del médico de familia, que debe evaluar al paciente de forma global, incluyendo los factores de riesgo, la comorbilidad, el tipo de FA y la valoración de los riesgos embólico y hemorrágico. La decisión de anticoagular o no se debe tomar pronto, en función del riesgo embólico del paciente y no del tipo de arritmia. Por otra parte se debe decidir, junto con el cardiólogo de referencia, la mejor estrategia terapéutica para cada paciente individual: control de ritmo (intentar recuperar y mantener el ritmo sinusal) o control de frecuencia (mantener la frecuencia cardíaca en límites aceptables). En ambas estrategias debe estar presente el tratamiento antitrombótico de base, ya que la complicación más grave, frecuente y de mayor repercusión en morbilidad y mortalidad es el ictus. Además, los ictus cardioembólicos (hasta 1 de cada 4 ictus) son especialmente devastadores, con mayor letalidad, consumo de recursos hospitalarios y sociales, y discapacidad asociada. El control de la FA y, en particular, la prevención continuada del ictus a través de una adecuada anticoagulación deben realizarse primordialmente en atención primaria. No obstante, el manejo multidisciplinar se impone en una mayoría de pacientes, donde debe establecerse una buena coordinación entre AP y especializada, en especial cardiología, hematología y neurología (en pacientes que ya presentaron un ictus) (AU)

The prevalence of atrial fibrillation (AF) in adults in Spain is estimated to be 4.4% of the population aged 40 years or more, corresponding to a mean of 30 to 40 patients per family physician. The importance of this common arrhythmia lies, above all, in its close association with stroke and other systemic embolisms, among other possible complications. Diagnosis of AF is based on electrocardiographic recording and can consequently be made by the family physician, who should make an overall assessment of the patient's health, including risk factors, comorbidity and type of AF and evaluate embolic and hemorrhagic risk. The decision to prescribe anticoagulation therapy or not should be taken promptly and should be based on the patient's embolic risk and not on the type of arrhythmia. In addition, the family physician, together with the treating cardiologist, should decide on the most appropriate therapeutic strategy for each individual patient: a rhythm control strategy (attempting to recover and maintain sinus rhythm) or a rate control strategy (maintaining heart rate within acceptable limits). Antithrombotic treatment should form part of both strategies, since stroke is the most serious and common complication of AF and also has the greatest effects on morbidity and mortality. Moreover, cardioembolic strokes (accounting for one out of every four strokes) are especially devastating, with the highest fatality, hospital and social resource use, and associated disability. Control of AF and particularly stroke prevention with adequate anticoagulation should be carried out mainly in primary care. Nevertheless, multidisciplinary management is required in most patients, which requires effective coordination between primary and specialized care, especially cardiology, hematology and neurology (in patients who have already had a stroke) (AU)

Negative impact of deep venous thrombosis on chronic venous disease.

INTRODUCTION: There are several conditions that may cause chronic venous disease (CVD). It is not known whether the aetiology of CVD can predict disease severity and quality of life (QoL). Our objective is that the severity and QoL of patients with CVD secondary to DVT is different from those without prior DVT. MATERIAL AND METHODS: We compare patients with CVD caused by DVT (n=125) and patients with non-DVT CVD (n=1435) with respect to disease severity (CEAP and Venous Clinical Severity Score-VCSS) and quality of life (Health Survey Short-Form-SF12 y Chronic Lower Limb Venous Insufficiency Questionnaire-CIVIQ20). RESULTS: Regarding to non-thrombotic CVD, patients with CVD due to DVT showed more severe disease [C6 grade (14.4% vs 3.6%) (p<0.05); score VCSS (1,33±0,65 vs 0,84±0,49) (p<0.05)] and poorer QoL [global score CIVIQ-20 (57,84±15,57 vs 65,75±14,07) (p<0.05); global score SF-12 (45,98±18,79 vs 57,79±19,64) (p<0.05).]. These differences remained statistical significant in all parameters - attributed measured at each severity score and QoL questionnaires. CONCLUSION: A history of DVT leads to worse clinical severity and quality of life in CVD patients. These data support even more the need to implement programs to prevent DVT and/or its evolutionary consequences.

Criterios de derivación entre niveles asistenciales de pacientes con patología vascular. Documento de consenso semFYC-SEACV / Criteria for between-care-level referrals of patients with vascular disease. semFYC-SEACV consensus document

La Sociedad Española de Medicina Familiar y Comunitaria (semFYC) y la Sociedad Española de Angiología y Cirugía Vascular (SEACV) han elaborado, mediante un grupo de trabajo conjunto, un documento de derivación entre niveles asistenciales de los pacientes con las principales patologías vasculares: enfermedad arterial periférica, insuficiencia venosa y pie diabético. Se han definido las responsabilidades y habilidades requeridas de cada nivel asistencial y también los criterios de derivación mutua, así como los de priorización. La elaboración de este documento consensuado pretende aportar una herramienta eficiente que asegure la continuidad en la asistencia sanitaria, respetando siempre las particularidades y necesidades específicas de cada zona sanitaria(AU)

The Spanish Society of Family and Community Medicine (semFYC) and the Spanish Society of Angiology and Vascular Surgery (SEACV), through a Joint Working Group, have prepared a document on between care-level referrals of patients with the main vascular diseases; peripheral arterial disease, venous insufficiency, and diabetic foot. The responsibilities and skills required at each care level have been defined, as well as the criteria for mutual referral and how to prioritise them. The preparation of this consensus document attempt to provide an efficient tool that may ensure the continuity of health care, always respecting the specific characteristics and needs of each health care area(AU)

Criterios de derivación entre niveles asistenciales de pacientes con enfermedad vascular. Documento de consenso SEMFYC-SEACV. Resumen ejecutivo / Criteria for referral between levels of care of patients with peripheral vascular disease. SEMFYC-SEACV consensus document

La coordinación entre niveles asistenciales constituye un elemento esencial para incrementar la eficiencia del sistema sanitario; en este sentido, la enfermedad vascular ocupa un lugar destacado por incluir entidades frecuentes, graves y vulnerables. Los documentos de consenso constituyen una herramienta fundamental para conseguir este objetivo. Este documento no pretende sustituir a las guías clínicas, sino que trata de establecer las bases del manejo compartido del paciente con enfermedad vascular (enfermedad arterial periférica, pie diabético e insuficiencia venosa crónica) en tres aspectos: determinar el perfil del paciente cuyo seguimiento ha de ser realizado de forma prioritaria en cada nivel; establecer las competencias que debe asumir cada profesional, y fijar y priorizar los criterios de derivación en ambos sentidos(AU)

Coordination between care levels is essential to increase the efficiency of the Health System; vascular disease has an important role in this respects, as it includes frequent, serious and vulnerable conditions. Consensus documents are an essential tool to obtain these aims. This document is not expected to replace the Clinical Guidelines, but tries to establish the basis of the shared management of the patient with vascular disease (peripheral arterial disease, diabetic foot, and chronic venous insufficiency) in three ways: to determine the profile of the patient who should receive priority follow-up at every level; to establish the skills that every professional must have, and to set and to prioritise the referral criteria in both directions(AU)

[Criteria for referral between levels of care of patients with peripheral vascular disease. SEMFYC-SEACV consensus document]. / Criterios de derivación entre niveles asistenciales de pacientes con enfermedad vascular. Documento de consenso SEMFYC-SEACV. Resumen ejecutivo.

Coordination between care levels is essential to increase the efficiency of the Health System; vascular disease has an important role in this respects, as it includes frequent, serious and vulnerable conditions. Consensus documents are an essential tool to obtain these aims. This document is not expected to replace the Clinical Guidelines, but tries to establish the basis of the shared management of the patient with vascular disease (peripheral arterial disease, diabetic foot, and chronic venous insufficiency) in three ways: to determine the profile of the patient who should receive priority follow-up at every level; to establish the skills that every professional must have, and to set and to prioritise the referral criteria in both directions.

[Criteria for between-care-level referrals of patients with vascular disease. semFYC-SEACV consensus document]. / Criterios de derivación entre niveles asistenciales de pacientes con patología vascular. Documento de consenso semFYC-SEACV.

The Spanish Society of Family and Community Medicine (semFYC) and the Spanish Society of Angiology and Vascular Surgery (SEACV), through a Joint Working Group, have prepared a document on between care-level referrals of patients with the main vascular diseases; peripheral arterial disease, venous insufficiency, and diabetic foot. The responsibilities and skills required at each care level have been defined, as well as the criteria for mutual referral and how to prioritise them. The preparation of this consensus document attempt to provide an efficient tool that may ensure the continuity of health care, always respecting the specific characteristics and needs of each health care area.

Validez y utilidad del péptido ventricular natriurético tipo B (BNP) en la detección de disfunción ventricular izquierda en pacientes de alto riesgo en atención primaria / Validity and usefulness of B-type natriuretic peptide (BNP) for early detection of left ventricular dysfunction in high-risk patients in Primary Care

Objetivo: Determinar la validez y utilidad del BNP en atención primaria para detectar la disfunción ventricular en pacientes asintomáticos con alto riesgo de insuficiencia cardiaca (IC). Diseño: Estudio descriptivo prospectivo y multicéntrico de validación de prueba diagnóstica. Emplazamiento: Consultas de atención primaria de 7 centros de salud de la comunidad de Madrid. Participantes: Muestra consecutiva de 204 pacientes asintomáticos con riesgo elevado de presentar IC (estadios A y B de la American Heart Association). Mediciones principales: Se recogieron datos de la anamnesis, exploración física, electrocardiograma, factores de riesgo de IC y tratamiento actual. Se determinó el BNP en sangre venosa en la propia consulta mediante Triage BNP Test® (Biosite®) realizándose en las siguientes 72h un ecocardiograma (prueba de referencia). Comparamos los niveles de BNP según presencia o ausencia de disfunción ventricular, tipo (sistólica/diastólica) y grado. Se calcularon la sensibilidad, especificidad y los valores predictivos para el mejor punto de corte en la curva ROC. Resultados: Los valores de BNP fueron más altos (p<0,001) en pacientes con disfunción sistólica ventricular izquierda (DSVI). No se hallaron diferencias significativas para la disfunción diastólica. El mejor punto de corte para la detección de DSVI fue 71,00 pg/ml, siendo el área bajo la curva de 0,757 (IC 95%: 0,64-0,87). La sensibilidad fue del 75% (IC 95%: 50,66-99,34), especificidad 70,19% (62,81-77,57), valor predictivo positivo 20% (IC 95%: 9,05-30,95) y valor predictivo negativo 96,58% (IC 95%: 92,86-100), siendo la prevalencia de DSVI en esta población del 9,04%. Conclusiones: El BNP puede tener utilidad en el diagnóstico precoz de DSVI en pacientes de alto riesgo de IC en consultas de atención primaria debido a su alto VPN (> 96%)(AU)

Objective: The aim of this study was to determine the accuracy of BNP test for early diagnosis of left ventricular dysfunction in patients at high-risk for heart failure. Design: Cross-sectional descriptive study. Setting: 7 Primary Care Centres in Madrid (Spain). Participants: A consecutive sample of 204 consecutive asymptomatic patients with high risk for heart failure (Stages A-B, AHA/ACC Classification). Main measurements: BNP plasma levels were measured in the clinical setting using Triage BNP Test® (Biosite®) and an echocardiography was performed in the following 3 days in a single hospital unit as a reference standard. Plasma BNP levels were compared depending on the presence/absence of left ventricular dysfunction (LVD), type and severity degree. Sensitivity, specificity, positive and negative predictive values, and Área under the receiver operating characteristic curve (ROC) for BNP assay were calculated. Results: BNP values were significantly higher (P<.001) in patients with left ventricular systolic dysfunction (LVSD). No significant differences were found for diastolic dysfunction. The best cut-off value to discriminate the patients with LVSD was 71.00 pg/ml, with an Área under the ROC curve of 0.757 (95% CI 0.64-0.87). Sensitivity for LVD diagnosis was 75% (95% CI 50.66-99.34), specificity 70.19% (95% CI 62.81-77.57), positive predictive value (PPV) 20% (95% CI 9.05-30.95), and negative predictive value (NPV) 96.58% (95% CI 92.86-100), with LVSD prevalence of 9.04% in this population. Conclusions: BNP determinations are of value in diagnosing LVSD in a primary care setting, with similar sensitivities and specificities. Due to the high NPV is useful to rule-out patients for echocardiography(AU)

[Validity and usefulness of B-type natriuretic peptide (BNP) for early detection of left ventricular dysfunction in high-risk patients in primary care]. / Validez y utilidad del péptido ventricular natriurético tipo B (BNP) en la detección de disfunción ventricular izquierda en pacientes de alto riesgo en atención primaria.

OBJECTIVE: The aim of this study was to determine the accuracy of BNP test for early diagnosis of left ventricular dysfunction in patients at high-risk for heart failure. DESIGN: Cross-sectional descriptive study. SETTING: 7 Primary Care Centres in Madrid (Spain). PARTICIPANTS: A consecutive sample of 204 consecutive asymptomatic patients with high risk for heart failure (Stages A-B, AHA/ACC Classification). MAIN MEASUREMENTS: BNP plasma levels were measured in the clinical setting using Triage BNP Test(®) (Biosite(®)) and an echocardiography was performed in the following 3 days in a single hospital unit as a reference standard. Plasma BNP levels were compared depending on the presence/absence of left ventricular dysfunction (LVD), type and severity degree. Sensitivity, specificity, positive and negative predictive values, and Área under the receiver operating characteristic curve (ROC) for BNP assay were calculated. RESULTS: BNP values were significantly higher (P<.001) in patients with left ventricular systolic dysfunction (LVSD). No significant differences were found for diastolic dysfunction. The best cut-off value to discriminate the patients with LVSD was 71.00 pg/ml, with an Área under the ROC curve of 0.757 (95% CI 0.64-0.87). Sensitivity for LVD diagnosis was 75% (95% CI 50.66-99.34), specificity 70.19% (95% CI 62.81-77.57), positive predictive value (PPV) 20% (95% CI 9.05-30.95), and negative predictive value (NPV) 96.58% (95% CI 92.86-100), with LVSD prevalence of 9.04% in this population. CONCLUSIONS: BNP determinations are of value in diagnosing LVSD in a primary care setting, with similar sensitivities and specificities. Due to the high NPV is useful to rule-out patients for echocardiography.