The evidence was downgraded by 1 increment if the majority of studies were rated at high risk of bias, and downgraded by 2 increments if the majority of studies were rated at very high risk of bias. (b) Inconsistency was assessed by inspection of the sensitivity/specificity plots. Particular attention was placed on the sensitivity threshold(s) set by the GC as an acceptable level to recommend a test. The evidence was: downgraded by 1 increment if the individual study values varied across 2 areas, where values of individual studies are above/below 50%, or above/below the acceptable threshold 95%. downgraded by 2 increments if the individual study values varied across 3 areas, where values of individual studies are above/below 50%, and above/below the acceptable threshold 95%. (c) Indirectness was assessed using the QUADAS-2 checklist items referring to applicability. The evidence was downgraded by 1 increment if the majority of studies are seriously indirect, and downgraded by 2 increments if the majority of studies are very seriously indirect. (d) Imprecision was assessed based on inspection of the confidence region for sensitivity in the diagnostic meta-analysis. The evidence was downgraded by 1 increment when there was a 20- 40% range of the confidence interval around the point estimate, and downgraded by 2 increments when there was a range of >40%. (e) One study reported the results of two BNP tests at this threshold: Axsym & Centaur (reported in that order in the table above). (f) Pooled sensitivity/specificity from diagnostic meta-analysis. (g) Three studies (n= 826) included in pooled analysis (one study only reported NPV and AUC and could not be pooled). Chronic Heart Failure Diagnosing heart failure NICE 2018. All rights reserved. Subject to Notice of rights. 