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BNP advised for all in heart failure

Testing for brain natriuretic peptides is better than an ECG and should be used in all patients with suspected heart failure before beginning treatment, new draft guidance recommends.

The guidance, from the Scottish Intercollegiate Guidelines Network, puts Scotland ahead of the game on heart failure

diagnosis, with GPs in the rest of the UK left uncertain about how to proceed.

SIGN rejects a single cut-off BNP value and instead recommends three bands: very low (ruling out heart failure), very high (making it extremely likely) and intermediate (necessitating further investigation).

But NICE, which advises either an ECG or BNP testing, is not due to review its heart failure guidelines until July next year, drawing criticism from experts demanding a more urgent response.

Dr Jerry Murphy, consultant cardiologist at Darlington Memorial Hospital and a researcher on the use of BNP in primary care, warned: 'Primary care is desperately keen to get clarification for what is the best way forward in diagnosing heart failure.'

Dr Jonathan Mant, senior lecturer in primary care at the University of Birmingham, who was involved in drawing up the NICE guidelines, said they had been kept deliberately vague because BNP testing was not yet widely available.

'The SIGN recommendation sounds reasonable, but I am keeping an open mind. The results from BNP have been very encouraging,' he said.

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