The study was rated as very low quality due to risk of bias, imprecision due to the range of the confidence interval around the point estimate and indirectness due a lack of information regarding the reference standard. The study reported a sensitivity and specificity of 81 (67-91) and 90 (80-96) respectively which did not meet the pre specified sensitivity of 95 which was set by the committee as a minimum threshold for possible recommendation. Economic No relevant economic evaluations were identified. 5.3.6 Recommendations and link to evidence Recommendations Measure N-terminal pro-B-type natriuretic peptide [NT-proBNP] in people with suspected heart failure. [2018] Because very high levels of NT-proBNP carry a poor prognosis, refer people with suspected heart failure and an NT-proBNP level above 2,000 ng/litre (236 pmol/litre) urgently, to have specialist assessment and transthoracic echocardiography within 2 weeks. [2018] Refer people with suspected heart failure and an NT-proBNP level between 400 and 2,000 ng/litre (47 to 236 pmol/litre) to have specialist assessment and transthoracic echocardiography within 6 weeks. [2018] Be aware that: an NT-proBNP level less than 400 ng/litre (47 pmol/litre) in an untreated person makes a diagnosis of heart failure less likely the level of serum natriuretic peptide does not differentiate between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. [2018] Review alternative causes for symptoms of heart failure in people with NT- proBNP levels below 400 ng/litre. If there is still concern that the symptoms Chronic Heart Failure Diagnosing heart failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 might be related to heart failure, discuss with a physician with a subspeciality interest in heart failure. 