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Cover of Testing for BNP and NT-proBNP in the Diagnosis and Prognosis of Heart Failure

Testing for BNP and NT-proBNP in the Diagnosis and Prognosis of Heart Failure

Evidence Reports/Technology Assessments, No. 142

, PhD, FCACB, , PT, PhD, , PhD, FCACB, , MD, MSc, , MBChB PhD, FCACB, FRCPC, , PhD, , MD, PhD, FRCPC, , BA, , MSc, , BSc, MSc, and , PhD.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 06-E014

Structured Abstract

Objectives:

The purpose of this systematic review was to evaluate BNP and NT-proBNP to: (a) identify determinants, (b) establish their diagnostic performance in heart failure (HF) patients, (c) determine their predictive ability with respect to mortality and other cardiac endpoints, and (d) determine their value in monitoring HF treatment.

Data Sources:

MEDLINE®, EMBASE, CINAHL, Cochrane Central and AMED from 1989 to February 2005 were searched for primary studies.

Review Methods:

Standard systematic review methodology, including meta-analysis, was employed.All study designs were included. Eligibility criteria included English-only studies and restricted the number of test methods to maximize generalizability. Outcomes for prognosis were limited to mortality and specific cardiac events. Further specific criteria were developed for each research question.

Results: Determinants:

There were 103 determinants identified including age, gender, disease, treatment, as well as biochemical and physiological measures. Few studies reported independent associations and of those that did age, female gender and creatinine levels were positively associated with BNP and NT-proBNP. Diagnosis: Pooled sensitivity and specificity values were 94 and 66 percent for BNP and 92 and 65 percent for NT-proBNP; there was minimal difference among settings (emergency, specialized clinics, and primary care). B-type natriuretic peptides also added independent diagnostic information above traditional measures for HF. Prognosis: Both BNP and NT-proBNP were found to be independent predictors of mortality and other cardiac composite endpoints in patients with risk of coronary artery disease (CAD) (risk estimate range = 1.10 to 5.40), diagnosed CAD (risk estimate range = 1.50 to 3.00), and diagnosed HF patients (risk estimate range = 2.11 to 9.35). With respect to screening, the AUC values (range = 0.57 to 0.88) suggested poor performance. Monitoring Treatment: Studies showed therapy reduced BNP and NT-proBNP, however, relationship to outcome was limited and not consistent.

Conclusions: Determinants:

The importance of the identified determinants for clinical use is not clear. Diagnosis: In all settings both BNP and NT-proBNP show good diagnostic properties as a rule out test for HF. Prognosis: BNP and NT-proBNP are consistent independent predictors of mortality and other cardiac composite endpoints for populations with risk of CAD, diagnosed CAD, and diagnosed HF. There is insufficient evidence to determine the value of B-type natriuretic peptides for screening of HF. Monitoring Treatment: There is insufficient evidence to demonstrate that BNP and NT-proBNP levels show change in response to therapies to manage stable chronic HF patients.

Contents

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Task Order Leaders: Cynthia Balion, PhD, FCACB; Parminder Raina, PhD (McMaster University EPC Director)

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0020. Prepared by: McMaster University Evidence-based Practice Center, Hamilton, ON, Canada.

Suggested citation:

Balion C, Santaguida P, Hill S, Worster A, McQueen M, Oremus M, McKelvie R, Booker L, Fagbemi J, Reichert S, Raina P. Testing for BNP and NT-proBNP in the Diagnosis and Prognosis of Heart Failure. Evidence Report/Technology Assessment No. 142. (Prepared by the McMaster University Evidence-based Practice Center under Contract No. 290-02-0020). AHRQ Publication No. 06-E014. Rockville, MD: Agency for Healthcare Research and Quality. September 2006.

This report is based on research conducted by the McMaster University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0020).The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers; patients and clinicians, health system leaders, and policymakers, make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

Drs. Hill, McQueen, and Worster have worked on BNP-related projects with Roche Diagnostics. Drs. Santaguida, Raina, McKelvie, Balion, and Oremus have no financial interest in this field, nor do Mr. Fagbemi, Ms. Booker, or Ms. Reichert.

1

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Bookshelf ID: NBK38136
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