Index diagnostic test + treatment NT-proBNP assay (at any reported threshold) Treatment/next step in pathway: Echocardiography Comparator index diagnostic tests + treatment BNP assay (at any reported threshold) Treatment/next step in pathway: Echocardiography Outcomes Efficacy outcomes: All-cause mortality Quality of life Unplanned hospitalisation Process outcomes: Number of people receiving echocardiography, i.e., including people who may not have needed it such as those with false positive results Repeat testing / additional testing Secondary accuracy outcomes: Sensitivity / specificity and other test accuracy measures Study design Systematic Review RCT 5.2.3 Clinical evidence A search was conducted for single gate studies assessing the diagnostic test accuracy of BNP or NT- proBNP to identify the presence of heart failure (as indicated by the reference standard) in people with atrial fibrillation and suspected heart failure in a community or outpatient setting. A search was also conducted for diagnostic RCTs comparing outcomes in patients tested with BNP versus NT- proBNP. No studies meeting either review protocol were identified. See also the study selection flow chart in Appendix C and excluded studies list in Appendix I. Chronic Heart Failure Diagnosing heart failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 5.2.4 Economic evidence Published literature No relevant economic evaluations were identified. See also the economic article selection flow diagram in Appendix D. New cost-effectiveness analysis Original economic analysis was planned for this question. However, due to a lack of diagnostic accuracy data for this cohort of patients modelling was not undertaken. 5.2.5 Evidence statements Clinical No clinical evidence was identified for this review question. Economic No relevant economic evaluations were identified. 