From the Guidelines
Trending Brain Natriuretic Peptide (BNP) levels in patients with decompensated Congestive Heart Failure (CHF) is not recommended as a routine practice for guiding management decisions, due to the lack of strong evidence supporting its clinical benefit in reducing morbidity, mortality, and improving quality of life. The use of BNP levels in monitoring treatment response and guiding management decisions in decompensated CHF is still being debated, with mixed results from clinical studies and significant inter- and intra-individual variability in BNP levels 1. While some studies suggest that BNP trending may provide objective data on the effectiveness of heart failure therapies, with decreasing levels indicating improvement in volume status and cardiac function, the evidence is not strong enough to support its routine use in clinical practice 1. In fact, the 2013 ACCF/AHA guideline for the management of heart failure only recommends the measurement of BNP or NT-proBNP to support clinical judgment for the diagnosis of acutely decompensated HF, but not for guiding treatment decisions 1. Key considerations in the use of BNP levels in CHF management include:
- The wide variation in single or sequential BNP levels in chronic heart failure after long-term medical therapy, making it difficult to establish a single "target" level 1
- The potential for over-aggressive diuresis based solely on BNP levels, which may increase the risk of renal azotemia or extend length of stay without reducing morbidity and mortality 1
- The need for comprehensive clinical evaluation, taking into account factors like renal dysfunction, obesity, and certain medications that can influence BNP levels independently of heart failure status 1. Overall, while BNP trending may have some potential benefits in specific clinical contexts, its routine use in guiding management decisions for patients with decompensated CHF is not supported by strong evidence, and a more cautious approach is recommended, prioritizing comprehensive clinical evaluation and individualized patient care.
From the Research
Benefits of Trending Brain Natriuretic Peptide (BNP) Levels
- Trending BNP levels can provide meaningful prognostic information in patients with decompensated Congestive Heart Failure (CHF) 2.
- A BNP-guided strategy has been shown to reduce the risk of CHF-related death or hospital stay for CHF in optimally treated patients 3.
- Serial measurements of BNP can help guide therapy for patients treated for acute decompensated heart failure, and may define a patient population that would benefit from specific therapies to reduce the risk 2.
Clinical Applications of BNP Trending
- BNP levels can be used to screen patients for left ventricular dysfunction and to tailor treatment of decompensated patients 4.
- Trending BNP levels can help assess the state of neurohormonal compensation of patients and guide adjustments to therapy 4, 5.
- A decrease in BNP levels by at least 30% has been proposed as a target for treatment, with patients who do not achieve this target being at higher risk for poor outcomes 2.
Comparison to Other Strategies
- The use of BNP-guided strategy has been compared to conventional strategies, such as urine output-guided diuretic treatment, and has been shown to be effective in reducing NT pro-BNP levels and improving symptoms 6.
- BNP-guided strategy has also been shown to be safe and effective in selected subgroups of patients with acute decompensated heart failure 6.