Evidence for the use of B-type natriuretic peptides for screening asymptomatic populations and for diagnosis in primary care

Objectives To determine the screening and diagnostic properties of BNP and NT-proBNP for heart failure in primary care. Design and methods We conducted a systematic review of randomized control trials and observational (cohort or case–control) studies of heart failure detection using B-type natriuretic peptides published in English from January 1989 to February 2005. We extracted or calculated sensitivity, specificity, positive and negative likelihood ratios, area under the receiver–operator characteristic curve and diagnostic odds ratio (DOR). Results We included 17 studies (7 screening, 9 diagnosis in primary care or specialised clinic, 1 both). There was considerable heterogeneity within the study populations, reference standard for diagnosis, and B-type natriuretic peptide decision point. Sensitivity ranged from 26% to 98%; and specificity from 44% to 88%. For screening, the Diagnostic Odds Ratio (DOR) ranged from 2.7 to 29, and for diagnosis from 2.8 to 137. Conclusions The performance characteristics of B-type natriuretic peptides measurement are not suitable for screening asymptomatic patients. For diagnosis in primary care, low B-type natriuretic peptide values may be used to rule-out heart failure but, due to poor specificity, high values cannot be used to rule-in the condition.