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Natriuretic peptides for heart failure screening in nursing homes: a systematic review

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Abstract

The high burden of heart failure in nursing-home populations is due to advanced age and comorbidities. Heart failure is often undiagnosed or misdiagnosed in this population and therefore remains untreated. We review the use of natriuretic peptide biomarkers for screening heart failure in nursing-home residents. The study was performed in accordance with recommendations from the Cochrane Collaboration using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and is registered in PROSPERO Register of Systematic Reviews. Databases PubMed, Embase, and Trip were searched from 2000 to March 2019, supplemented by hand-searching of references. Studies investigating the nursing-home population were included. The prevalence of heart failure among nursing-home residents was higher than in the general population of comparable age (23% vs 10%, respectively). The rate of misdiagnosis in nursing homes ranged from 25 to 76%. NT-proBNP was the most commonly used natriuretic peptide biomarker for heart failure screening. The mean value of NT-proBNP was significantly higher in residents with heart failure than in residents overall (pooled means of 2409 pg/mL vs 1074 pg/mL, respectively). In comparison with current guidelines, the proposed cut-off values for ruling out heart failure were higher in the analyzed studies, with ranges of 230–760 pg/mL for NT-proBNP and 50–115 pg/mL for BNP. NT-proBNP and BNP are used for screening heart failure in the nursing-home population. The current screening cut-off values are probably too low for use in nursing homes. Our most conservative estimation for ruling out heart failure is an NT-proBNP cut-off value of 230 pg/mL.

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Funding

The review was financially supported by the Slovenian Research Agency: projects ID 0339, J3-9292, and J3-9284. SM reports a research fellowship from the Slovenian Research Agency

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Authors and Affiliations

  1. Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia

    Vesna Homar, Spela Mirosevic, Igor Svab & Mitja Lainscak

  2. Community Health Centre Vrhnika, Vrhnika, Slovenia

    Vesna Homar

  3. Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia

    Mitja Lainscak

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  1. Vesna Homar
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Correspondence to Vesna Homar.

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ML reports a research grant from Roche Diagnostics.

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Brief summary

Natriuretic peptides are important in screening heart failure in the nursing-home population. This review paper challenges the current guideline-driven cut-off values for ruling out heart failure.

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Homar, V., Mirosevic, S., Svab, I. et al. Natriuretic peptides for heart failure screening in nursing homes: a systematic review. Heart Fail Rev 26, 1131–1140 (2021). https://doi.org/10.1007/s10741-020-09944-w

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