Natriuretic peptides to rule-in and rule-out a diagnosis of acute heart failure
Topic Status Complete
Natriuretic peptides to rule-in and rule-out a diagnosis of acute heart failure in adults in the emergency department setting
Outcome of the appraisal
The evidence supports the routine adoption of N-terminal pro B-type natriuretic peptide (NT-proBNP) measurement to rule-in and rule-out acute heart failure in adults presenting to the emergency department in whom there is clinical suspicion of this diagnosis.
The addition of NT-proBNP measurement to routine clinical assessment may reduce length of hospital stay and the rate of re-hospitalisations.
Health economic modelling indicates that NT-proBNP to rule-in and rule-out acute heart failure is the most cost-effective strategy.
Why was this topic appraised?
Acute heart failure (AHF) is the most common reason for emergency admission to hospital in England and Wales in adults older than 65 years, and the prevalence is increasing because of a progressively aging population. AHF can be challenging to diagnose since the symptoms often overlap with other acute conditions and patients with AHF often have other co-morbidities.
There is no single diagnostic test for heart failure. Diagnosis relies on a combination of clinical, imaging and biochemical assessment. Testing for the presence of elevated levels of natriuretic
peptides, such as NT-proBNP and BNP, facilitates the diagnosis of AHF although other conditions can also lead to increased levels of these proteins.
National Institute for Health and Care Excellence (NICE) AHF guidelines (2014) recommend the measurement of BNP or NT-proBNP to rule-out AHF, but they do not make any recommendations for ruling-in AHF. A strategy of using BNP or NT-proBNP to rule-in as well as rule-out AHF could allow for the better targeting of investigations as well as earlier diagnosis and treatment, which may lead to better clinical outcomes, and use of healthcare resources.
HTW identified this topic through HealthTechConnect.
Plain language summary
Heart failure occurs when the heart is unable to pump blood around the body properly. This means that the body doesn’t get the oxygen it needs and this can lead to shortness of breath, fatigue and can cause excess fluid to build up in the body, causing swelling around the ankles, feet and stomach. Heart failure is a life-threatening condition. It can be caused by damage to the heart muscle, a heart valve not functioning properly, an abnormal heart rhythm and other causes.
Heart failure is diagnosed using clinical judgement based on a combination of the patient’s history, physical examination, blood tests, electrocardiograms (ECGs), chest X-rays and echocardiograms. It can be difficult to diagnose as people with heart failure often have other illnesses that share the same symptoms.
Biomarkers are naturally occurring molecules that can be seen in blood tests. The presence of a specific biomarker in a blood test can be a sign of what is happening in a person’s organs/body. N-terminal pro B-type natriuretic peptide (NT‑proBNP) and B-type natriuretic peptide (BNP) are biomarkers released from the heart when the walls of the heart are stretched.
HTW looked for evidence that NT-proBNP or BNP can be used as biomarkers to both rule-in and rule-out a diagnosis of acute heart failure. The evidence supports the routine adoption of NT-proBNP measurement to rule-in and rule-out a diagnosis of acute heart failure in adults in the hospital emergency department setting.