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Why do we never order BNPs for CHF?


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6 minutes ago, codebar said:

An attending told me that it is an expensive test, 50 to 100$, I don't know if it is true.  Also it is neither sensitive nor specific. IMHO, BNP is only useful when the diagnosis is unclear. Don't quote me on this... Uptodate is a better ressource :)

Isn't BNP testing highly sensitive to rule in or rule out suspected HF?  CCS guidelines and BC guidelines both recommend BNP/NT-proBNP testing as a part of initial evaluation to confirm diagnosis IIRC... But I don't know how that translates to actual practice. :(

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It is a highly sensitive test for HF, around 90-97% depending on what cut off you choose - check out the Breathing Not Properly study and the PRIDE study. Like some mentioned,  BNP or NT-proBNP is currently recommended to rule in or out CHF if the diagnosis is unclear. It is particularly well studied in the patient presenting with dyspnea & clinical uncertainty.  In clinical practice, I've seen it be used in this context, usually by cardiology and rarely by ED, FM, IM - although where I was training only cardiologists were supposed order BNP levels to avoid its misuse. I've also seen it been used in to trend a patients levels if presenting with new or worsening symptoms. In BC, the cost of the test is around $42, so I believe the thought is that it should be sent only it will impact your clinical management. This may change in the future, possibly in areas such as prognosis and illness severity.

 

 

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You can order it pretty easily in BC. I got it in the ER there a few times.

I told a preceptor this in Ontario once and she didn't believe me so she called the lab and they told her they can get a BNP but it has to ship to Toronto for the results, at which point, that would be pretty useless.

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Its center dependent, unfortunately not all centers do them because of $ and other reasons. 

In Toronto:

NT-proBNP is available at St. Mikes with a very fast turn around (hours). I do it all the time there. 

I believe BNP is available at Sunnybrook with a fast turn around as well. If I remember correctly same goes for Mount Sinai. 

BNP at UHN takes 2-3 days to get back so its pretty useless in the moment.

 

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On 7/17/2017 at 4:21 PM, ACHQ said:

Its center dependent, unfortunately not all centers do them because of $ and other reasons. 

In Toronto:

NT-proBNP is available at St. Mikes with a very fast turn around (hours). I do it all the time there. 

I believe BNP is available at Sunnybrook with a fast turn around as well. If I remember correctly same goes for Mount Sinai. 

BNP at UHN takes 2-3 days to get back so its pretty useless in the moment.

 

This is the best answer. It's all centre dependent. BNP is a great test, and not that expensive, wish I could order it at my institution but the turn around time is >1 week which is essentially useless. During residency, I worked in hospitals that could get it overnight, which is extremely helpful in ruling out CHF. 

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