Serial NT-proBNP Measurements and Implementation of Guideline-Directed Medical Therapy

Heart failure (HF) guidelines give a Class I recommendation for measuring N-terminal proBNP) for diagnosis and prognosis in patients with HF. Although the importance of a single measurement of NT-pro BNP is well established, there has been ongoing debate regarding the utility of serial NT-proBNP measurements, fueled in part by the neutral results of the GUIDE-IT trial, which showed no benefit with NT-proBNP guided therapy compared to usual care.1 Although current guidelines include a Class 2a recommendation to obtain a predischarge NT-proBNP among patients hospitalized with HF to assess trajectory and establish postdischarge prognosis, the guidelines are silent regarding the utility of routine serial measurement of NT-proBNP in outpatient practice. There remain several knowledge gaps regarding the prognostic importance of serial NT-proBNP measurements in the outpatient setting and the implications for the therapeutic approach.