ACC indicates American College of Cardiology; AHA, American Heart Association; ADHF, acute decom- pensated heart failure; BNP, B-type natriuretic peptide; COR, Class of Recommendation; ED, emergency department; HF, heart failure; NT-proBNP, N-terminal pro-B-type natriuretic peptide; NYHA, New York Heart Association; and pts, patients. I A Measurement of baseline levels of natriuretic peptide biomarkers and/ or cardiac troponin on admission to the hospital is useful to establish a prognosis in acutely decompensated HF.27,93 100 MODIFIED: Current recommendation emphasizes that it is admission levels of natriuretic peptide biomarkers that are useful. See Online Data Supplements A and B. Higher levels of natriuretic peptide biomarkers on admission are usually associated with greater risk for clinical outcomes, including all-cause and cardiovascular mortality, morbidity, and composite outcomes, across different time intervals in patients with decompensated HF.20,27,29,93 101 Similarly, abnormal levels of circulating cardiac troponin are commonly found in patients with acute decompensated HF, often without obvious myocardial ischemia or underlying coronary artery disease (CAD), and this is associated with worse clinical outcomes and higher risk of death.95,99,102,103 Studies have demonstrated incremental prognostic value of these biomarkers to standard approaches of cardiovascular disease risk assessment.29,95 However, there were differences in the risk prediction models, assay cutpoints, and lengths of follow-up.29 Furthermore, not all patients may need biomarker measurement for prognostication, especially if they already have advanced HF with established poor prognosis or persistently elevated levels of biomarkers in former settings. Therefore, assays of natriuretic peptide biomarkers for incremental prognostication should not preclude good clinical judgment; an individualized approach to each patient is paramount. IIa B-NR During a HF hospitalization, a predischarge natriuretic peptide level can be useful to establish a postdischarge prognosis.93,96,104 113 NEW: Current recommendation reflects new observational studies. 