6.1.3 NPs for the management of chronic HFrEF

Recommendation 23: We suggest, in ambulatory patients with HFrEF, measurement of BNP or NT-proBNP to guide management should be considered to decrease HF-related hospitalizations and potentially reduce mortality. The benefit is uncertain in individuals older than 75 years of age (Weak Recommendation, Moderate Quality Evidence).

Values and preferences: These recommendations are based on multiple small randomized controlled trials (RCTs), most of which demonstrated benefit, and 3 meta-analyses, which universally demonstrated benefit. An ongoing RCT is likely to affect this recommendation.

Practical tips:

• A change in NP levels by > 30% probably reflects more than daily variation in patients with compensated HF.
• The timing of NP measurements in outpatient settings should be dictated according to clinical status; NP measurments should be used when they might aid in clinical decision making.