Use of B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP (NT-proBNP) as Diagnostic Tests in Adults With Suspected Heart Failure: A Health Technology Assessment.

B-type natriuretic peptide and NT-proBNP tests have high sensitivity and low negative likelihood ratio, suggesting that concentrations of either natriuretic peptides within the appropriate cut points can rule out the presence of heart failure with a high degree of confidence. Additionally, BNP or NT-proBNP testing along with usual care in an ED setting likely can reduce the length of hospital stay by at least 1 day but likely results in little to no difference in hospital mortality, 30-day readmission, or admission rates to hospital.Based on the published economic literature, we expected BNP or NT-proBNP tests used in addition to standard clinical investigations to be cost-effective as a rule-out test in patients with suspected heart failure in Ontario. If BNP and NT-proBNP tests are publicly funded in Ontario, we estimated that there would be additional costs in the ED setting (due to increased detection of heart failure) and savings in community care (due to reduced referrals to echocardiography and cardiologists).People we interviewed gave BNP and NT-proBNP testing strong support, citing the perceived benefits of quicker, more accurate diagnoses that could reduce misdiagnoses, stress, and the burden on patients and caregivers.