Pro B-type Natriuretic Peptide (NT-proBNP) (Guidelines)

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AUDIENCE

• Primary Care
• HHSCP only
• Adults

What is NTproBNP?

NTproBNP is a hormone released by the heart in response to ventricular stretch eg fluid overload. Active BNP hormone causes natriuresis, diuresis and vasodilation.  NTproBNP is an inactive form of BNP, which has been chosen for analysis as it is more stable than BNP.

When should NTproBNP be requested?

• As part of the investigations for a patient with suspected heart failure.
• The result should be used to decide if an echochardiography referral is needed.
• Echocardiography is recommended in patients with suspected heart failure who have a raised NT-proBNP level or an abnormal ECG.

When not to request NTproBNP

Patients with classic signs of acute decompensated heart failure or patients with a previous history of myocardial infarction and symptoms suggestive of heart failure these patients should be referred for urgent ECHO without delay. In order to avoid a delay in referral while waiting for an NTproBNP result.

• Shortness of breath consistent with other aetiologies.
• Screening for asymptomatic ventricular dysfunction.
• General monitoring of treatment for heart failure, except for prescribing Entresto where NTproBNP may be requested under the guidance of Cardiology. If so please indicate this on the request form.

Sample requirements and test information

Implementation

• Requests for NTproBNP will vetted to ensure that the test is being used appropriately.
• You must indicate on the request form the reason for the NTproBNP request.
• NTproBNP may only be measured once per year on a patient. More frequent requests will be rejected. The Duty Biochemist (ext 5931) should be contacted for exceptional cases.