Monitoring using other biomarkers or repeated cardiac imaging (echocardiography or cardiac MRI) No studies comparing usual care with monitoring with troponin or combinations of different biomarkers, repeated echocardiography, or cardiac 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 MRI were identified. Trade-off between clinical benefits and harms Natriuretic peptide monitoring General heart failure population Age and comorbidities In people under 75 years of age, NP monitoring was associated with a clinically important reduction in deaths (58 fewer per thousand (from 103 fewer to 0 fewer)) and admissions (68 fewer per thousand (from 136 fewer to 4 more)) without a substantial increase in the incidence of adverse events. The committee felt that, while there was some uncertainty in this evidence, it was likely that some people under 75 years of age would benefit from NP monitoring in clinical practice. The committee agreed that the evidence supported a recommendation to consider NP monitoring in patients under 75 years of age. The evidence suggested that in people aged 75 and older, NP monitoring may result in clinically significant increase in numbers of deaths and admissions, with an average of 59 extra deaths per thousand (from 56 fewer to 200 more) and 24 extra admissions (from 47 fewer to 91 more). In terms of adverse events, there was a suggestion that people aged 75 years and older receiving NP monitoring may be more likely to develop hyperkalaemia and hypotension, although there was no clinically significant difference in the incidence of renal failure. 