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NT Pro BNP Testing

Checked: 23-08-2021 by Vicky Ryan Next Review: 23-08-2022

Overview

The NT Pro BNP blood test will act as a ‘rule out‘ test for the diagnosis of left ventricular systolic dysfunction.

Measure serum natriuretic peptides (N-terminal pro-B-type natriuretic peptide [NTproBNP])) in all patients with suspected heart failure (previous exclusions sucha as previous MI and AF no longer apply)

In addition please undertake the following bloods: FBC, renal function, LFTs, lipids, HbA1C and TFTs.

BNP testing should be performed in all patients with suspected heart failure.

Blood samples may be taken in primary care, and the test should be ordered through the ICE system. There are no special requirements for delivery of these blood samples to the laboratory.

BNP testing is carried out immediately upon receipt of the sample, with a turnaround time of <24 hours from receipt in the laboratory to electronic reporting back to primary care. High results are flagged as abnormal. There is an expectation that practices will pick up and urgently refer patients with a NTproBNP level above 2000 pg/ml.

Red Flags

Because very high levels of serum natriuretic peptides carry a poor prognosis, refer patients with suspected heart failure and a NTproBNP level above 2000 pg/ml urgently for specialist assessment within 2 weeks. Do not refer for an echocardiogram first as this can delay referral and will be done at the assessment appointment.

For advice on urgent referral please see the Heart Failure section of Remedy.

Interpretation of result

Heart failure is unlikely if the NT-proBNP level is < 400 pg/ml

If result is <400 pg/ml, consider an alternative diagnosis.

If there is ongoing clinical concern that this may be heart failure, consider referral to the heart failure service in primary care setting; please refer to ‘Accessing the Heart Failure Service in BNSSG’ guidance and ‘Primary Care Heart Failure Treatment’ guideline on the Heart Failure page. For in-patients, please refer to the hospital-based heart failure team/cardiology.

If the result is >400 pg/ml, see the the Heart Failure page for advice on next steps.

Please be aware of the following when interpreting the result:

Obesity, African or African–Caribbean family origin, or treatment with diuretics, angiotensin-converting enzyme (ACE) inhibitors, beta‑blockers, angiotensin II receptor blockers (ARBs) or mineralocorticoid receptor antagonists (MRAs) can reduce levels of serum natriuretic peptides
High levels of serum natriuretic peptides can have causes other than heart failure (for example, age over 70 years, left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia [including pulmonary embolism], renal dysfunction [eGFR less than 60 ml/minute/1.73 m²], sepsis, chronic obstructive pulmonary disease, diabetes, or cirrhosis of the liver.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.