title: Performance of BNP and NT-proBNP for diagnosis of heart failure in primary care patients: a systematic review.
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.
authors: Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada.
authors: Ronald A
authors: RA
authors: Booth
authors: Stephen A
authors: SA
authors: Hill
authors: Andrew
authors: A
authors: Don-Wauchope
authors: P Lina
authors: PL
authors: Santaguida
authors: Mark
authors: M
authors: Oremus
authors: Robert
authors: R
authors: McKelvie
authors: Cynthia
authors: C
authors: Balion
authors: Judy A
authors: JA
authors: Brown
authors: Usman
authors: U
authors: Ali
authors: Amy
authors: A
authors: Bustamam
authors: Nazmul
authors: N
authors: Sohel
authors: Parminder
authors: P
authors: Raina
mesh_terms: D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011320:Primary Health Care
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain