Evidence for the use of B-type natriuretic peptides for screening asymptomatic populations and for diagnosis in primary care.
OBJECTIVE
To determine the screening and diagnostic properties of BNP and NT-proBNP for heart failure in primary care.


METHODS
We conducted a systematic review of randomized control trials and observational (cohort or case-control) studies of heart failure detection using B-type natriuretic peptides published in English from January 1989 to February 2005. We extracted or calculated sensitivity, specificity, positive and negative likelihood ratios, area under the receiver-operator characteristic curve and diagnostic odds ratio (DOR).


RESULTS
We included 17 studies (7 screening, 9 diagnosis in primary care or specialised clinic, 1 both). There was considerable heterogeneity within the study populations, reference standard for diagnosis, and B-type natriuretic peptide decision point. Sensitivity ranged from 26% to 98%; and specificity from 44% to 88%. For screening, the Diagnostic Odds Ratio (DOR) ranged from 2.7 to 29, and for diagnosis from 2.8 to 137.


CONCLUSIONS
The performance characteristics of B-type natriuretic peptides measurement are not suitable for screening asymptomatic patients. For diagnosis in primary care, low B-type natriuretic peptide values may be used to rule-out heart failure but, due to poor specificity, high values cannot be used to rule-in the condition.
Hill
Stephen A
SA
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.
Balion
Cynthia M
CM
Santaguida
Pasqualina
P
McQueen
Matthew J
MJ
Ismaila
Afisi S
AS
Reichert
Sonja M
SM
McKelvie
Robert
R
Worster
Andrew
A
Raina
Parminder S
PS
D016022:Case-Control Studies; D015331:Cohort Studies; D016208:Databases, Factual; D006333:Heart Failure / Q000175:diagnosis* / Q000378:metabolism; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D020097:Natriuretic Peptide, Brain / Q000032:analysis*; D010446:Peptide Fragments / Q000032:analysis*; D016032:Randomized Controlled Trials as Topic
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain