Other biomarkers have been identified but their utility is unclear. It considered that any marker chosen should be widely available, have an extensive evidence base, and good performance characteristics including high stability in patient samples given transfer times between primary care and central laboratory facilities. Though current practice favours the use of biomarkers for diagnosis rather than monitoring their future use cannot be predicted. Thus, the ability to interconvert between assays based on the same biomarker and the ability to clearly define baseline levels to allow long-term management by monitoring would be prudent to maintain. After consideration of the available assays222 , their performance and and recent publications that inform the rest of the guideline the GDG decided that NT-proBNP should be the favoured biomarker as it was more commonly used, more stable, did not require additional laboratory specimens for ideal performance248 and did not suffer from potential confounding of interpretation by novel therapies (e.g. sacubitril-valsartan)303 . Chronic Heart Failure Introduction NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 2.5 Rationale for the update This guideline is a partial update of NICE Guideline No 108: Chronic Heart Failure in adults . The 2010 guidelines offered advice on best practice for the care of adult patients (aged 18 years or older) who have symptoms or a diagnosis of chronic heart failure. Since and North American374 guidelines, based on new high-quality evidence from randomised controlled trials in diagnosis, treatment and monitoring have been published. A partial update of the existing NICE guideline is necessary to ensure that the recommendations take into account the new evidence available. Diagnosis of heart failure depends on clinical symptoms and signs with imaging usually echocardiography - and increasingly laboratory measured biomarkers such as natriuretic peptides (chapter 5). 