5.2.5 Evidence statements Clinical No clinical evidence was identified for this review question. Economic No relevant economic evaluations were identified. 5.3 BNP and NT-proBNP in diagnosing heart failure in people with chronic kidney disease 5.3.1 Review question: In people with suspected heart failure who also have chronic kidney disease, what thresholds of N-terminus pro-B-type natriuretic peptide (NT-proBNP) and B- type natriuretic peptide (BNP) are most accurate in identifying heart failure (as indicated by the reference standard)? For full details see review protocol in Appendix A. Table 22: Characteristics of review question Population People with chronic kidney disease (excluding patients on dialysis) and suspected heart failure in a community or outpatient setting. Target condition Heart failure Index test(s) NT-proBNP BNP Reference standard(s) A clinical diagnosis based on the opinion of at least one cardiologist, considering symptoms (potentially with some signs) and objective evidence of cardiac dysfunction (either structural or functional). Statistical measures Diagnostic accuracy of BNP and NT-proBNP: 2x2 tables Specificity Sensitivity PPV/NPV ROC curve or Area under Curve Study design Single gate studies (cohort/cross-sectional) Chronic Heart Failure Diagnosing heart failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 5.3.2 Review question: In people with suspected heart failure who also have chronic kidney disease, what is the clinical and cost effectiveness of N-terminus pro-B-type natriuretic peptide (NT-proBNP) compared to B-type natriuretic peptide (BNP), when each is followed by the appropriate patient pathway, in order to improve patient outcomes? For full details see review protocol in Appendix A. Table 23: PICO characteristics of review question Population People with chronic kidney disease (excluding patients on dialysis) and suspected heart failure in a community or outpatient setting. 