Natriuretic peptide tests in suspected acute heart failure

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1164 (Published 04 March 2015) Cite this as: BMJ 2015;350:h1164
  1. Frans H Rutten, associate professor of general practice,
  2. Arno W Hoes, professor of clinical epidemiology and general practice
  1. 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
  1. Correspondence to: F H Rutten F.H.Rutten{at}umcutrecht.nl

A reliable tool for assessing acutely breathless patients

Heart failure should always be considered in patients with shortness of breath and reduced exercise tolerance, especially older people, and irrespective of comorbidities such as chronic obstructive pulmonary disease.1 Symptoms and signs are rarely enough for diagnosis, and additional investigations usually follow.2 Measuring the serum concentration of natriuretic peptides improves diagnostic accuracy in patients with suspected heart failure in the non-acute setting,3 4 5 and evidence for these tests also being helpful in patients with suspected acute heart failure is growing.

International guidelines now recommend measuring natriuretic peptide concentrations, and set age independent but different exclusionary thresholds for the acute and non-acute setting.2 Although age independent thresholds are an attractive option in daily practice, their diagnostic accuracy has not yet been established. In a linked diagnostic meta-analysis (doi:10.1136/bmj.h910), Roberts and colleagues evaluated thresholds for plasma B type natriuretic peptide (BNP, ≤100 ng/L), N terminal probrain natriuretic peptide (NTproBNP, ≤300 ng/L), and mid-regional proatrial natriuretic peptide (MRproANP, ≤120 pmol/L) recommended for excluding heart failure in acute care settings such as emergency departments. …

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