However, the Zaphiriou study (high quality study assessing both BNP and NT-proBNP) assessed the recommended industry cut-offs for each test. When comparing this data NT-proBNP thresholds have a consistently higher sensitivity than the BNP thresholds. 2. NT-proBNP has a longer stability in blood samples than BNP (days vs 4-6 hours), therefore NT-proBNP is more appropriate for testing in primary care. 3. Sacubitril Valsartan interferes with BNP physiology (TA388). Natriuretic peptides can also be used for monitoring heart failure patients. Therefore, the committee considered it would be more useful to have NT-proBNP as the baseline peptide in case monitoring was needed in a patient with heart failure who is subsequently treated with this drug. The test thresholds at which data was sought were 125pg/mL, 280 pg/mL and 400 pg/mL. The thresholds were selected based on the data already available in the included studies and to minimise the amount of additional data that needed to be collected, while still allowing for assessment of accuracy at key clinically relevant thresholds used in existing NICE guidelines and other international guidance. The results of the requests for additional data meant that meta-analysis of three studies was possible at each of the above thresholds. Unfortunately, despite all three studies being of high quality and enrolling seemingly similar populations, the pooled data was of very low quality due to serious inconsistency and serious imprecision. For this reason, the committee had little confidence in the pooled estimates of sensitivity and specificity. Suspected heart failure and CKD One diagnostic accuracy study was included that evaluated the diagnostic accuracy of BNP at diagnosing heart failure in a population with CKD and respiratory distress. 