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Natriuretic peptides for heart failure screening in nursing homes : a systematic review
Homar, Vesna, zdravnica ...
The high burden of heart failure in nursing-home populations is due to advanced age and comorbidities. Heart failure is oftenundiagnosed or misdiagnosed in this population and therefore remains ...untreated. We review the use of natriuretic peptidebiomarkers for screening heart failure in nursing-home residents. The study was performed in accordance with recommendationsfrom the Cochrane Collaboration using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement(PRISMA) and is registered in PROSPERO Register of Systematic Reviews. Databases PubMed, Embase, and Trip weresearched from 2000 to March 2019, supplemented by hand-searching of references. Studies investigating the nursing-homepopulation were included. The prevalence of heart failure among nursing-home residents was higher than in the general popu-lation of comparable age (23% vs 10%, respectively). The rate of misdiagnosis in nursing homes ranged from 25 to 76%. NT-proBNP was the most commonly used natriuretic peptide biomarker for heart failure screening. The mean value of NT-proBNPwas significantly higher in residents with heart failure than in residents overall (pooled means of 2409 pg/mL vs 1074 pg/mL,respectively). In comparison with current guidelines, the proposed cut-off values for ruling out heart failure were higher in theanalyzed studies, with ranges of 230 760 pg/mL for NT-proBNP and 50 115 pg/mL for BNP. NT-proBNP and BNP are used forscreening heart failure in the nursing-home population. The current screening cut-off values are probably too low for use innursing homes. Our most conservative estimation for ruling out heart failure is an NT-proBNP cut-off value of 230 pg/mL.
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