Evidence map›Paper›PMID 40717271›Full record

ArticleESC heart failure2025

Age-adjusted natriuretic peptide thresholds for a diagnosis of heart failure in the community: Diagnostic accuracy study.

Clare J Taylor, Kathryn S Taylor, Nicholas R Jones, Jose M Ordóñez-Mena, Antoni Bayes-Genis, F D Richard Hobbs

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in ESC heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed.

  1. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Clare J TaylorDepartment of Applied Health Sciences, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK.ORCID https://orcid.org/0000-0001-8926-2581
Kathryn S TaylorNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Nicholas R JonesNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Jose M Ordóñez-MenaNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Antoni Bayes-GenisHeart Institute, University Hospital Germans Trias i Pujol, Barcelona, Spain.
F D Richard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

Funding

National Institute for Health and Care Research
6 · The paper itself

Abstract

backgroundEuropean Society of Cardiology (ESC) chronic heart failure (HF) guidelines recommend a single N-terminal pro-B-type natriuretic peptide (NT-proBNP) threshold of ≥125 pg/mL for specialist referral in symptomatic patients; however, natriuretic peptide levels increase with age.

objectivesWe aimed to assess NT-proBNP test performance at age-adjusted thresholds recently proposed by the ESC Heart Failure Association (HFA).

methodsDiagnostic accuracy study using linked primary and secondary care data (2004-2018) in England. NT-proBNP test performance at ESC HFA age-adjusted rule-in thresholds (≥125 pg/mL, ≥250 pg/mL and ≥500 pg/mL for <50 years, 50-74 years and ≥75 years, respectively) and a high-risk threshold (≥2000 pg/mL) was assessed overall, by sex and body mass index (BMI) with ESC's suggested threshold reductions for obesity.

resultsOf 155 347 patients with NT-proBNP tests performed, 14 585 (9.4%) were diagnosed with HF. Current ESC single threshold of ≥125 pg/mL had sensitivity 94.6% [95% confidence interval (CI) 94.2-95.0] and specificity 50.0% (49.7-50.3). Age-adjusted thresholds had reduced sensitivity (83.5%, 88.5%, 84.4%) but increased specificity (77.6%, 67.8%, 63.5%) across the respective age groups. The high-risk threshold had sensitivity 38.9% (38.1-39.7) and specificity 96.1% (96.0-96.2). A high BMI was associated with lower sensitivity at each age-adjusted threshold, which improved with adjustment by obesity category. Test performance was similar in women and men.

conclusionsAt ESC HFA age-adjusted thresholds, the number of referrals required for HF diagnostic assessment are substantially reduced, but with some (likely lower risk) cases initially being undetected. Lower thresholds for patients with obesity are needed to avoid missing HF cases, but there is no need for adjustment by sex.

Indexed as

Heart FailureNatriuretic Peptide, BrainPeptide FragmentsAgedAge FactorsBiomarkersEnglandFemaleFollow-Up StudiesHumansMaleMiddle AgedRetrospective StudiesBiomarkersNatriuretic Peptide, BrainPeptide Fragmentspro-brain natriuretic peptide (1-76)diagnosisdiagnostic accuracyheart failurenatriuretic peptide testing

Identifiers

PMID40717271
PMCPMC12450762

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.