Role and scope of NP monitoring The committee discussed the heterogeneous nature of the NP-guided treatment protocols used in the included studies. Some studies treated to an absolute NP target; others set a personal target based on percentage drop in NP levels; and others did not aim to reduce NP levels, but used serial measurements to detect increases thought to represent deterioration and acted accordingly. The variation in the NP-guided treatment protocols made it difficult for the committee to specify a particular model of NP monitoring, but the committee agreed that the greatest benefit of NP monitoring would be as part of a treatment optimisation protocol. The reduction in deaths and hospitalisation would be most significant for people in higher risk categories, such as those who are newly diagnosed or have had a recent deterioration, and require medication titration. An NP guided treatment protocol should not, however, override clinical assessment and judgement. It was not proposed that NP levels be routinely measured in stable patients on optimised medication, as such patients would likely gain little from the intervention. Type of NP measured The committee noted that across the included studies, both BNP and NT- proBNP monitoring was utilised. The committee agreed however that NT- proBNP should be the preferred NP for monitoring for two key reasons. Firstly, one of the recommended drugs for treating heart failure interferes with BNP physiology (Sacubitril valsartan - TA388). Secondly, concerns were raised by the committee about the stability of BNP samples. BNP is stable in a blood sample for only 4-6 hours while NT-proBNP is stable for days. 