Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Point-of-care BNP testing may be helpful to rule out heart failure
Clinical Question
What is the diagnostic accuracy of natriuretic peptide point-of-care testing for heart failure?
Bottom line
Sensitivity—the ability to rule out heart failure if the test result is negative—is high for point-of-care B-type natriuretic peptide (BNP) testing in ambulatory settings, using a cutoff of at least 100 pg/mL. Its specificity—the ability to rule in heart failure with a positive test result—varies widely. Only 5 studies have evaluated the use of point-of-care BNP testing in primary care settings. No studies have evaluated whether its use improves patient outcomes. 1a
Reference
Study design: Meta-analysis (other)
Funding: Government
Setting: Outpatient (any)
Synopsis
These researchers searched 8 databases, including Cochrane CENTRAL, to identify 37 studies that evaluated point-of-care BNP testing in ambulatory settings, including emergency departments, any outpatient setting, and primary care. They included studies in all languages. Two reviewers selected studies for inclusion and extracted the data. Most studies (n = 30) evaluated BNP testing, though 7 studies evaluated N terminal fragment pro B-type natriuretic peptide (NTproBNP) testing. The authors allowed echocardiography, clinical examination, or the combination to be the reference standard. Of the 5 studies done in primary care, sensitivity was high (95%; 95% CI 90% - 98%) using a cutoff of 100 pg/mL, dropping off substantially with cutoffs of less than 100 pg/mL Specificity ranged widely across the studies (range 31% - 98%). The risk of bias of the study designs was assessed as low. There was no evidence of publication bias.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Potentially useful since may lead to more management decisions being made in an ambulatory setting. Would be great if this facilitated primary care docs in making treatment decisions. Hookers is as reviewer noted - no outcome studies have been done. Also will add to overhead office costs unless POC testing funding by governments.
Nice to be reminded of sense & sensitivity. This review really helps to move forward with patients who are dyspneic in a noisy clinical setting where clinical signs are indistinct or not diagnostic
I am an older physician History Physical and a chest Xray works very well
I will also add that we were taught that CHF is NOT a Diagnosis !!! One needs to find the cause.
weak study that is apparently not in support of clinical assessment ( if needed at all ! ).
BNP is not a useful test. I encourage readers to peruse the literature review: https://emergencymedicinecases.com/bnp-diagnosis-acute-chf/
Good poem
Cannot use it because in Alberta family doctors are not allowed to order BNP. So it is useless in primary care.