What is the recommendation for using NT-proBNP to refer a patient for echocardiography when heart failure is suspected in a patient presenting with signs and symptoms of heart failure in primary care?
The committee recommended that an NT-proBNP level of 400pg/ml be used to refer a patient for echocardiography when heart failure is suspected in a patient presenting with signs and symptoms of heart failure in primary care. This was based on the results of the economic analyses, which found that this threshold had the highest probability (62%) of being the most cost effective strategy at the 20,000 per QALY gained threshold compared to other diagnostic strategies. The results were further supported by the fact that this threshold had both the highest sensitivity and highest specificity of all diagnostic strategies, which indicated that it would yield the best diagnostic accuracy. Additionally, this threshold was considered to be driven by the high proportion (76%) of HF-REF in the heart failure population for this study, as those with HF-REF receive a greater QALY benefit of being diagnosed and treated than those with HF-PEF.   