Use of B-type natriuretic peptide outside of the emergency department

In contrast to their established role in the evaluation of acute dyspnea in emergency department (ED) patients, applications of B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) in patients outside of the ED are less well defined. A PubMed-based electronic and hand search for articles dealing with BNP and NT-proBNP in settings other than the ED was performed. We found that currently available evidence is sufficient to support the use of BNP and NT-proBNP in four cardiovascular settings outside of the ED: i) evaluation of patients with suspected heart failure (HF) referred from primary care, ii) risk stratification in patients with HF, iii) risk stratification in stable coronary artery disease, and iv) risk stratification in pulmonary artery hypertension. Recent studies indicate that BNP and NT-proBNP might also be helpful in guiding therapy in patients with chronic HF. Despite active research in many additional fields, the use of BNP/NT-proBNP in other settings is not yet based on solid evidence and, therefore, seems not to be useful.