From the Guidelines
BNP serial monitoring is not established as useful to reduce hospitalizations or mortality in patients with heart failure, but it can be useful to support clinical decision making in the diagnosis of heart failure and to establish prognosis or disease severity in outpatients with chronic heart failure. When considering BNP serial monitoring in heart failure patients, it is essential to understand its limitations and potential benefits. According to the guidelines released by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) 1, BNP or NT-proBNP measurement can be useful in supporting clinical decision making in the diagnosis of heart failure, especially when there is clinical uncertainty. Some key points to consider when using BNP serial monitoring in heart failure patients include:
- Measurement of BNP or NT-proBNP can be useful in establishing the prognosis or disease severity in outpatients with chronic heart failure 1.
- BNP- or NT-proBNP–guided therapy can be useful to achieve optimal dosing of medical therapy in select clinically euvolemic outpatients in structured management programs 1.
- However, the usefulness of serial measurement of BNP or NT-proBNP to reduce hospitalizations or mortality in patients with heart failure has not been established 1. In clinical practice, BNP serial monitoring should be used judiciously, taking into account the individual patient's clinical context and other factors that may affect BNP levels, such as renal dysfunction, obesity, and age.
From the Research
BNP Serial Monitoring in Heart Failure
- B-type natriuretic peptide (BNP) is a biomarker used to diagnose and estimate the prognosis of heart failure (HF) 2.
- Serial BNP measurements can inform medication adjustments and guide therapy in HF, particularly in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) 2.
- Studies have shown that NP-guided therapy can reduce cardiac events and mortality in patients with HFrEF, especially those aged <75 years 2.
- However, the use of BNP-guided therapy in heart failure with preserved ejection fraction (HFpEF) and in the acute setting has not shown significant benefits 2.
Indications for BNP Serial Monitoring
- BNP serial monitoring can be useful in identifying patients at high risk for poor outcomes, such as those who do not respond to treatment 3.
- Serial BNP measurements can also help identify patients who are likely to experience a worsening of their condition or die during short-term follow-up 4.
- The use of BNP serial monitoring can provide meaningful prognostic information and help guide therapy in patients with HF 3, 4.
Frequency of BNP Measurements
- The frequency of BNP measurements can vary depending on the patient's condition and the clinical setting 5, 6.
- Serial BNP measurements can be taken at admission, discharge, and at follow-up appointments to monitor the patient's response to treatment 4, 5.
- The use of reference change values (RCV) can help interpret the results of serial BNP measurements and determine the significance of changes in BNP levels over time 6.
Clinical Implications
- BNP serial monitoring can help clinicians make informed decisions about patient care and guide therapy in HF 2, 3, 4.
- The use of BNP serial monitoring can also help identify patients who are at high risk for poor outcomes and may benefit from more aggressive or targeted therapy 3, 4.
- Further research is needed to fully understand the clinical implications of BNP serial monitoring in HF and to determine the optimal frequency and interpretation of BNP measurements 2, 5, 6.