Updated Heart Failure Guidelines Support Use of BNP, NT-proBNP in Clinical Decision-Making

Updated guidelines by the American College of Cardiology and American Heart Association on the management of heart failure (HF) more clearly define the role of the natriuretic peptides, B-type natriuretic peptide (BNP) and N-terminal (NT) pro-BNP, in supporting clinical decision-making in diagnosing and establishing the prognosis for HF (Circulation 2013; doi: 10.1161/CIR.0b013e31829e8776). The writing committee, comprised of general cardiologists, HF and transplant specialists, electrophysiologists, general internists and physicians with methodological expertise, set the highest level of evidence, A, for these uses of natriuretic peptides. The committee found less convincing evidence to support the use of natriuretic peptides in achieving optimal dosing of guideline-directed medical therapy and in reducing hospitalizations or mortality in patients with HF, rating both these recommendations as level B evidence.

The guideline also gives level A evidence to using BNP, NT-proBNP, and/or cardiac troponin in establishing prognosis or disease severity in acutely decompensated HF. The committee suggested, with A level evidence, that BNP or NT-proBNP can be useful in supporting the diagnosis of acutely decompensated HF, especially when clinicians are uncertain about the diagnosis. However, the guideline only found C-level evidence for using BNP or NT-proBNP in guiding therapy for acutely decompensated HF.

The guideline is a thorough reassessment of HF diagnosis beyond both the previous full guideline published in 2005, and a 2009 focused update.

The authors call for future research to identify a convincing method to use biomarkers to optimize medical therapy.