Values and Preferences: This recommendation is based on multiple small RCTs, all of which demonstrated an association with clinical outcomes. Although the risk of readmission is decreased with lower NP levels, clinicians should also consider the limitations of delaying discharge from the hospital for this purpose.
Practical Tip: We suggest that individuals with risk factors for the development of HF, NP levels be used to implement pharmacologic therapy in order to prevent HF. An increased level of NP of BNP > 100 pg/mL and NT-proBNP > 300 pg/ mL, higher values than those used in the 2 trials discussed below to avoid over screening, along with the presence of risk factors for HF, should at least trigger more intensive follow up (see Prevention of HF).
A change of 30% in NP level likely exceeds the day-to-day variation and is in general considered relevant. For ambulatory patients with HF who are evaluated in the clinic, a NP level that increases more than 30% should therefore call for more intensive follow-up and/or intensified medical treatments, even if they are not congested clinically. The latter can include diuretic therapy or intensification of ACE inhibitors, β-blockers and mineralocorticoid receptor antagonists if their doses are not yet at the targets defined by clinical trials.
For patients who are about to be discharged from the hospital, physicians should ensure that the patients are relatively free from congestion clinically and with a NP level that is significantly lower than that on admission for HF. A suggested algorithm for management of different stages of HF using NP is shown in Figure 3.