The levels of NPs for ruling in and ruling out a diagnosis of HF are shown in Table 9. NP levels differ for the diagnosis of patients seen in the acute (e.g., emergency department [ED]) versus in the outpatient settings. Several high quality studies have reported on the utility of NPs for the diagnosis of HF in the outpatient setting where NPs are ideally suited to assist in ruling out HF as a diagnosis, but cannot be used independent of signs, symptoms, and other diagnostic information.
Recommendation 21: We recommend that BNP/NT-proBNP levels be measured to help confirm or rule out a diagnosis of HF in the acute or ambulatory care setting in patients in whom the cause of dyspnea is in doubt (Strong Recommendation, High Quality Evidence).
Values and preferences: High quality RCT evidence in the Canadian setting also demonstrates favorable cost-effectiveness. Elevated NP levels are recommended as an additional diagnostic criterion for HFpEF and are associated with increased risk, although the levels may be lower than in HFrEF. Older age and comorbidities may also influence variations in NP levels.
Recommendation 22: We recommend that measurement of BNP/NT-proBNP levels be considered in patients with an established diagnosis of HFrEF for prognostic stratification, in view of optimizing medical therapy (Strong Recommendation, High Quality Evidence).
Practical tip: