1. Upcoming National Audit Brain Natriuretic Peptide
Dr Gareth McKeeman
Consultant Clinical Scientist, Clinical Biochemistry,
Belfast Health & Social Care Trust
Royal Victoria Hospital, Belfast

2. BNP / NT-proBNP Protein secreted by wall of the heart when stretched
Affect body fluid homeostasis – natriuresis & diuresis
134 aa prepropeptide cleaved to proBNP – when released cleaved to NT-proBNP (inert) & BNP (active)
Concentration raised in a number of conditions – including heart failure
Most value for assisting with diagnosis of CHF

3. BNP in the Guidelines

4. ESC Guidelines 2016 Non-acute cut-offs for rule out:
BNP = <35 pg/mL; NT-proBNP = <125 pg/mL
Acute setting – for rule out:
BNP = <100 pg/mL; NT-proBNP = <300 pg/mL
acute presentation – ED/CCU/ICU

5. BNP Cut-offs – Does variation exist?
McCullough & Kluger, JACC; 71:

6. BNP Testing Information
Assay used – BNP/NT-proBNP
Manufacturer
Lab /POCT
Trust Guidelines available
Primary/Secondary Care
Test numbers
Min. Retest Intervals
TAT
Ref ranges

7. BNP Over-requesting? BHSCT Previous audit 2016
Ambulatory Cardiology Unit – 29% of NT-proBNP tests inappropriate
Audit of all requests 2017 (all sites)
Significant repeat NT-proBNP testing
30 day MRI introduced BHSCT

8. BNP Analysis & Reporting
Are labs aware of IFCC guidelines & assessing URL?

9. How is BNP being used?
Aim to determine if BNP/NT-proBNP requesting is in line with the NICE standards
Clinical aspect to the audit – review sample requests from primary & secondary care and if referral for Echo/CHF specialist
Aiming for 30 requests at 3 BNP cut-points to be reviewed clinically
Primary Care:
Are patient’s with BNPs under cut-points still getting Echo’s? Are patients with raised BNPs being referred appropriately?
Secondary Care:
Is there repeat BNP testing / CHF specialist referral / follow-up after discharge?

10. Acknowledgements Thank-you Dr S Gidwani, NHSCT Dr M Toal, BHSCT
Dr D McCall, BHSCT
Dr L Dixon, BHSCT
Dr A Kearney, SHSCT
Dr M Harbinson, BHSCT
Thank-you