People with heart failure and atrial fibrillation The committee discussed NP monitoring in patients with HF and AF. In the absence of evidence in this subgroup, and given the effect of AF itself on NP levels the committee agreed that no recommendation could be made on this topic. Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Recommendations Consider measuring NT-proBNP (N-terminal pro-B-type natriuretic peptide) as part of a treatment optimisation protocol only in a specialist care setting for people aged under 75 who have heart failure with reduced ejection Monitoring using other biomarkers or repeated cardiac imaging (echocardiography or cardiac MRI) Given the absence of evidence on the clinical effectiveness of monitoring using other troponin, combinations of biomarkers, or repeated cardiac imaging, the committee agreed to make no recommendation in these areas. The committee acknowledged its related research recommendation on the added value of cardiac MRI in the diagnosis of heart failure and its aetiology, and considered that further research in that area would be necessary before developing an evidence base for the use of cardiac imaging as a monitoring tool. Trade-off between net clinical effects and costs Three economic evaluations (two from a UK perspective and one from an Austrian perspective) were identified and included in this review comparing NP monitoring to usual care. The Austrian cost-utility analysis assessed patients with heart failure who had recently been discharged after a heart failure hospitalisation. The study compared usual care by a primary care physician as well as usual care by a nurse-led multidisciplinary team (MDT) to intensive NP monitoring. Mortality and hospitalisation rates were taken from Berger et al. 2010 identified in the clinical review. 