Expert consensus on the usefulness of natriuretic peptides in heart failure

Abstract

Heart failure (HF) has becoming an increasing clinical and social problem worldwide and despite modern therapy the syndrome still imposes high burden on healthcare systems. In contrast to western countries, the diagnosis of HF in Poland is established later, at more advanced stage of the disease, thus leaving less time for modern therapy and more frequently requiring hospitalisation. As a result, the alarmingly high proportion of patients with HF is treated in hospitals in Poland. According to current guidelines clinical suspicion of HF should be verified based on early assessment of plasma levels of natriuretic peptides. Unfortunately, the key test for early diagnosis, especially in emergency departments and in general practice is not reimbursed and therefore hardly available. The paper provides a short review on the physiology and pathophysiology of natriuretic peptides. Important laboratory issues as well as limitations of their use in specific clinical situations are briefly discussed. Further, we focus on clinical use of natriuretic peptides as an important tool for HF diagnosis, guiding therapy and prognosis. Finally, we put spotlight on the use of natriuretic peptides in prevention of HF and also in ambulatory general practice.

Prevalence of self-reported heart failure in the adult Polish population: results of the NATPOL 2011 study

“…NTproBNP level was measured in 2258 participants. A cut-off level for plasma NT-proBNP was defined as per the current ESC guidelines as >125 pg/ml [4].…”

“…The 2016 guidelines have introduced a diagnostic algorithm for CHF and highlighted the role of natriuretic peptides in the initial assessment. Increased blood natriuretic peptide levels indicate an activation of a compensatory mechanism that precedes the development of clinical manifestations of heart failure [4].…”

Cardiac emergencies during the coronavirus disease 2019 pandemic in the light of the current evidence

“…[19][20][21] Natriuretic peptides, the concentration of which should be interpreted in the context of previously diagnosed heart failure (HF), are potential quantitative markers of cardiac wall stress. 22 It is known that elevated natriuretic peptide levels are a predictor of death in pneumonia or pulmonary embolism (PE). The assessment of their concentration may help to stratify the risk and imply diagnostic decisions.…”

Comprehensive Heart Failure Care pilot study: starting point and expected developments

“…The main goal is to "limit the occurrence of consequences of HF," while the specific objectives are as follows: early discovery of HF and determination of its etiology, inhibiting disease progression, optimizing the use of healthcare resources in HF care, improving lives and longevity of patients with HF as well as limiting the exacerbation of the disease. [9][10][11][12] Aims of the KONS are focused on removing the existing problems and improving the effectiveness of HF treatment. An early diagnosis Their hierarchy will resemble a pyramid, where POZ facilities would be the foundation, vertically integrated with hospitals of various reference levels (FIGURE 1).…”