Description of Test:
With a prevalence of 4.8 to 5 million cases, congestive heart failure (CHF) is a major health problem in the United States, with 550,000 new cases being diagnosed each year. Diagnosis of CHF may be difficult, even in emergency care settings, as the symptoms tend to be non-specific. Other more specific diagnostic and prognostic tools, such as echocardiography and cardiac catheterization, are either too invasive, too costly, or impractical to use for rapid assessment of symptomatic patients. Considering that early medical treatment of CHF may prolong life and reduce symptoms, a search for an inexpensive, readily available, easy to perform, and highly predictive test for CHF has occurred that ultimately has centered around the cardiac natriuretic peptides. The plasma levels of such peptides increase based on the amount of myocardial wall stretch and stress with greater increases in more severe CHF. Thus, natriuretic peptides may be an indicator of severity of CHF. The most commonly discussed natriuretic peptide in the literature is B-type natriuretic peptide (BNP) which is the subject of this assessment. Through the measurement of plasma levels, BNP is proposed to provide additional discriminatory information in terms of the detection, diagnosis, prognosis, and monitoring of CHF.

Committee Conclusions:
With regard to B-type natriuretic peptide (BNP) for the screening, diagnosis and monitoring of congestive heart failure (CHF), the ICSI Technology Assessment Committee concludes:

1. The BNP test is safe, requiring only a routine venipuncture.
   
2. There are no data to support the use of BNP in the general screening of asymptomatic populations for CHF, and thus BNP testing should not be used for this purpose.
   
3. BNP measurements are useful as an adjunct to other clinical tools for differentiating cardiac (CHF) causes from other causes of dyspnea presenting in the emergency department or urgent care setting. In particular, the diagnosis of CHF is highly unlikely in patients with normal BNP levels. Care should be taken when measuring BNP within 2 to 4 hours after the onset of acute symptoms as false negatives may occur (Conclusion Grade II).
   
4. The utility of BNP as a tool to optimize management of heart failure or measure treatment response has yet to be defined. Serial testing of BNP levels has not been shown to have clinical utility.