Authors' objectives:

This report set out to determine the role of B-type natriuretic peptides in the diagnosis of heart failure in Scotland. More specifically, the HTA investigated whether or not a normal BNP (B-type natriuretic peptides) or NT-proBNP result can reliably rule out heart failure: - in the primary care setting to inform the decision to refer a patient to a specialist or for echocardiography - in the admissions setting to inform decisions around treatment and placement of patients.

Authors' results and conclusions: B-type natriuretic peptide testing has similar sensitivity but greater specificity for selecting patients to refer to specialists for electrocardiograms read by cardiologists. The accuracy of B-type natriuretic peptide testing is greatest in patients with more severe disease and poorest in patients who are receiving therapy for heart failure. There is no evidence that the accuracy of BNP differs from that of NT-proBNP. Modelling results suggested that using B-type natriuretic peptide tests could be cost saving if the specificity of diagnostic tests currently used to inform whether or not to refer patients for echocardiography is less than 50%. The cost-effective use of B-type natriuretic peptide testing may reduce the number of patients who are referred inappropriately for further cardiac assessment from general practice, and decrease the length of stay and total treatment costs in the acute setting. The decision on the type of testing service offered will depend on local requirements. Factors to consider include the need for a timely quality-assured test result to inform clinical decision making and the cost and practicality of providing these results. Patients would value avoiding unnecessary anxiety waiting for a diagnosis of heart failure if a more sensitive and relatively non-invasive test can 'rule out' heart failure.

Authors' recommendations: B-type natriuretic peptide testing should: - be used in conjunction with the results of other diagnostic tests - be used in the absence of a reliable electrocardiogram report - be used if there is genuine diagnostic uncertainty in patients after standard evaluation and no timely access to echocardiography - not replace echocardiography for the diagnosis of heart failure. Patients should be given clear information (including written information) about their diagnosis and how it was made. Research is needed to identify relevant cut-offs for different settings and different patient subgroups, particularly the elderly.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nhshealthquality.org/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Scotland

Organisation Name: Quality Improvement Scotland

Contact Address: Delta House, 50 West Nile Street Glasgow G1 2NP Scotland United Kingdom Tel: +44 141 225 6988; Fax: +44 141 221 3262

Contact Name: shtg.hcis@nhs.net

Contact Email: shtg.hcis@nhs.net

Copyright: NHS Quality Improvement Scotland (NHS QIS)