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B-Type Natriuretic Peptide Testing Useful for Diagnosing Heart Failure
BNP is a small protein that is secreted by the ventricles of the heart into the bloodstream when the heart is under stress. Elevated levels of BNP may indicate the presence of heart failure; a low-cost blood test that works in 15 minutes can detect a patient’s level of BNP. ECRI, an independent nonprofit health services research agency with more than 35 years of experience, published its findings on BNP testing in a Windows on Medical Technology™ health technology assessment report, “B-Type Natriuretic Peptide for Diagnosing Heart Failure.”
ECRI studied the use of BNP testing to aid diagnosis of heart failure in three populations: asymptomatic members of the general population, patients presenting to the emergency room with symptoms of heart failure, and patients presenting at the physician’s office with symptoms of heart failure. As explained in the report, ECRI conducted a comprehensive and systematic search for studies that met a set of predetermined inclusion criteria. Whenever possible, data were pooled using meta-analysis. When meta-analysis was not possible, ECRI conducted a systematic narrative review to evaluate the relevant evidence on the basis of quality, quantity, and consistency.
Evidence was available to reach conclusions for all three populations. Among the conclusions reached were that BNP testing can detect heart failure when used to screen asymptomatic members of the general population; this conclusion is based on strong evidence (i.e., data on a total of 7,198 patients in eight trials). In patients with chronic symptoms, BNP testing can detect heart failure, although the evidence supporting this conclusion is weak. ECRI’s analysis also found that BNP testing in the emergency room to aid diagnosis of heart failure improved several outcomes; those outcomes were decreased mortality and a decrease in the percentage of patients hospitalized, although the evidence supporting this conclusion was weak (i.e., from only one trial).
The absence of adverse events associated with the use of the BNP test, its low cost, and the available evidence on effectiveness led ECRI to conclude that use of the BNP test in any clinical setting was likely to improve patient outcomes.