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  1. Richard Lehman, MRCGP, MA
  1. Department of Primary Care, Oxford University
 Oxford, UK

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    Would you like to know when you are going to die? I am not sure that I would, and I don’t know that I want to be able to predict death in my patients either, unless it might help me to do something about it—either to postpone death, or plan for a better one. B type natriuretic peptide (BNP) is the best biochemical marker for predicting death. That was first demonstrated in a post-myocardial infarct cohort in Dundee, Scotland in 1994, and you might expect that—BNP is, after all, only elevated in response to cardiac ventricular overload or inflammation. But now the original Dundee investigators have looked at 299 patients, with a mean age of 79 years and a wide range of cardiac and non-cardiac impairment, and found that BNP is strongly predictive of mortality in them too (

    ) . I guess that if our hearts are strained, we die sooner, and that if we are dying, our hearts feel the strain.Which brings us to the vexed question of diagnosing and treating “heart failure.” You cannot have …

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