Heart failure unlikely
- What else could it be?

Heart failure unlikely
- What else could it be?


Even with a normal NT-proBNP, clinicians can still refer to a heart failure specialist if they think the patient has heart failure. Perhaps write a little more on why you are convinced the patient has heart failure in your referral.

Click here to find NICE advice about what else could it be?

Factors that can reduce levels of serum natriuretic peptides

  • Obesity;
  • African or African–Caribbean family background;
  • Treatment with diuretics;
  • Angiotensin-converting enzyme (ACE) inhibitors;
  • Beta‑blockers;
  • Angiotensin II receptor blockers (ARBs);and
  • Mineralocorticoid receptor antagonists (MRAs).

Factors that can increase levels of serum natriuretic peptides other than heart failure

  • Age over 70 years;
  • Left ventricular hypertrophy;
  • Ischaemia;
  • Tachycardia;
  • Right ventricular overload;
  • Renal dysfunction [eGFR less than 60 ml/minute/1.73 m2];
  • Sepsis;
  • chronic obstructive pulmonary disease;
  • Diabetes;and
  • Cirrhosis of the liver.

You will find more about the causes of elevated natriuretic peptides in the resources section at the end of the diagnosis section.

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(c) British Society for Heart Failure, 2022-
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