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Performance of BNP and NT-proBNP for diagnosis of heart failure in primary care patients: a systematic review

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An Erratum to this article was published on 09 August 2014

Abstract

National and international guidelines have been published recommending the use of natriuretic peptides as an aid to the diagnosis of heart failure (HF) in acute settings; however, few specific recommendations exist for governing the use of these peptides in primary care populations. To summarize the available data relevant to the diagnosis of HF in primary care patient population, we systematically reviewed the literature to identify original articles that investigated the diagnostic accuracy of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in primary care settings. The search yielded 25,864 articles in total: 12 investigating BNP and 20 investigating NT-proBNP were relevant to our objective and included in the review. QUADAS-2 and GRADE were used to assess the quality of the included articles. Diagnostic data were pooled based on three cutpoints: lowest and optimal, as chosen by study authors, and manufacturers’ suggested. The effect of various determinants (e.g., age, gender, BMI, and renal function) on diagnostic performance was also investigated. Pooled sensitivity and specificity of BNP and NT-proBNP using the lowest [0.85 (sensitivity) and 0.54 (specificity)], optimal (0.80 and 0.61), and manufacturers’ (0.74 and 0.67) cutpoints showed good performance for diagnosing HF. Similar performance was seen for NT-proBNP: lowest (0.90 and 0.50), optimal (0.86 and 0.58), and manufacturers’ (0.82 and 0.58) cutpoints. Overall, we rated the strength of evidence as high because further studies will be unlikely to change the estimates diagnostic performance.

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Acknowledgments

This manuscript is based on the research conducted by the McMaster Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290 2007-10060-I). The findings and conclusions in this paper are those of the authors, who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality. No statement herein 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. Parminder Raina holds a Tier 1 Canada Research Chair in Geroscience and the Raymond and Margaret Labarge Chair in Research and Knowledge Application for Optimal Aging.

Conflict of interest

Ronald A. Booth, Stephen A. Hill, Andrew Don-Wauchope, P. Lina Santaguida, Mark Oremus, Robert McKelvie, Cynthia Balion, Judy A. Brown, Usman Ali, Amy Bustamam, Nazmul Sohel, and Parminder Raina have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada

    Ronald A. Booth

  2. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada

    Stephen A. Hill, Andrew Don-Wauchope & Cynthia Balion

  3. Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, MIP Suite 309A, Hamilton, ON, L8S 4K1, Canada

    P. Lina Santaguida, Mark Oremus, Judy A. Brown, Usman Ali, Amy Bustamam, Nazmul Sohel & Parminder Raina

  4. Department of Medicine, McMaster University, Hamilton, ON, Canada

    Robert McKelvie

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Booth, R.A., Hill, S.A., Don-Wauchope, A. et al. Performance of BNP and NT-proBNP for diagnosis of heart failure in primary care patients: a systematic review. Heart Fail Rev 19, 439–451 (2014). https://doi.org/10.1007/s10741-014-9445-8

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