6.1.4 NPs for the management of decompensated chronic HFrEF

Recommendation 24: We suggest that measurement of BNP or NT-proBNP in patients hospitalized for HF should be considered before discharge, given the prognostic value of these biomarkers in predicting rehospitalization and mortality (Strong Recommendation, Moderate Quality Evidence).

Values and preferences: This recommendation is based on multiple small RCTs, all of which demonstrated an association with clinical outcomes.

Practical tip:

• A patient with persistently elevated NP levels might need closer follow-up in order to reduce the risk of rehospitalization.
• For patients who are about to be discharged from the hospital after a HF hospitalization, the NP level should be lower than that on admission. If NP levels remain elevated, clinicians should re-evaluate the patient’s condition and consider the possibility of delaying discharge from the hospital to optimize therapy and further reduce the NP level.