Recognise the symptoms

Young or old, look out for any of the three red flag symptoms:¹




Swollen legs and/or ankles



It is important to test your patients' NT-proBNP levels if they present with any one of these symptoms and you suspect heart failure.


Heart failure can affect all ages and genders. Keep an open mind if a patient presents with one or more of these key symptoms.


Read the NICE Guidelines

Think heart failure 1st

One simple test could help transform lives.

Benefits of testing NT-proBNP


Triage patients at need

of urgent specialist



Rule-out heart failure and

reduce pressure on

echocardiography services1


Costs less than £28 per

patient (compared to £337

for an echocardiogram)4



Early and accurate diagnosis of

heart failure has the potential to

reduce rates of misdiagnosis and

GP appointments2

An early diagnosis of heart failure can:


Enable faster access to

effective treatments and

improve patient outcomes



Reduce emergency

hospital admissions6




Listen to our podcast now

Nick Hartshorne-Evans, CEO of the Pumping Marvellous Foundation and Dr Clare Taylor, academic GP, take a deep dive into the world of heart failure in this new 18-minute podcast.


Discover the importance of early heart failure detection, how GPs can support this to ensure evidence-based treatments are delivered sooner, emergency hospitalisations are prevented, and the quality and longevity of patients’ lives are improved.



Listen to the podcast now

Heart Failure 1st

NICE Guidelines on heart failure


The journey to heart failure diagnosis according to the NICE Guidelines

The following diagram is a helpful tool that outlines a typical heart failure diagnosis as recommended by NICE.


Read the NICE Guidelines

Updates to the NICE heart failure quality standards

On 10th January 2023, NICE Guidelines updated the quality standards of chronic heart failure to include new recommendations for the detection, diagnosis and management of heart failure.


Read the quality standards


© NICE [2018] Chronic heart failure in adults: diagnosis and management. Available from www.nice.org.uk/guidance/ng106. All rights reserved. Subject to Notice of rights
NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

One simple blood test

NICE guidelines recommend that testing for natriuretic peptide (NP) testing (either NT-proBNP and BNP) should be the priority test when patients present with any of the symptoms of heart failure.


Yet currently less than 24% of patients have an NT-proBNP test prior to a heart failure diagnosis.


8 in 10 patients receive their diagnosis following a hospital admission, despite 4 in 10 presenting with symptoms to their GP in the years prior to their diagnosis with one of these key symptoms




Just ONE quick test can rule out heart failure 

What is NT-proBNP?

NT-proBNP is a form of natriuretic peptide (NP) released by cardiac tissue in response to volume and/or pressure overload that causes the walls of the heart to stretch. NPs promote natriuresis and diuresis and act as vasodilators, to help regulate this pressure.8


Why test for NT-proBNP?

NT-proBNP has a very high diagnostic sensitivity for heart failure and testing in patients with symptoms delivers a fast route to ruling out heart failure as a diagnosis. High levels of NT-proBNP are associated with a poor prognosis. Patients with values >2,000 ng/l are at greater risk of death9. High levels therefore indicate the need for urgent referral3.


Understand the results

The following information has been sourced from the NICE guidelines. High levels of natriuretic peptides are associated with a poor prognosis and indicate the need for urgent referral and management.

  • NT-proBNP >2000 pg/mL should be referred for transthoracic Doppler 2D echocardiography and specialist assessment within 2 weeks because such high levels carry a poor prognosis.
  •  NT-proBNP 400-2000 pg/mL should be referred for transthoracic Doppler 2D echocardiography and specialist assessment within 6 weeks.
  • NT-proBNP of <400 pg/mL in an untreated patient makes a diagnosis of heart failure highly unlikely.3



If you’ve had trouble accessing NT-proBNP testing, contact Roche and we’ll be happy to help.


Contact Us



People with heart failure are often living with several long term conditions; a large study using UK data found that 79% of people with heart failure had three or more comorbidities.10 Patients may assume their symptoms are related to these other conditions or to side effects of medications they are taking. In a survey of 110 primary care clinicians, 80% reported that multiple comorbidities were the biggest challenge in recognising potential heart failure in patients.11

Respiratory comorbidities, renal dysfunction, anaemia, arthritis, cognitive dysfunction and depression, among others, often lead to heart failure being overlooked in primary care.12

Type 2 diabetes and heart failure

Co-existence of type 2 diabetes and heart failure is associated with worse symptoms and quality of life, a greater burden of heart failure hospitalisation, and higher mortality rates compared to patients without type 2 diabetes mellitus.13

  • Approximately 14% of type 2 diabetes patients in the UK have heart failure14.
  • The incidence of heart failure increases 10-15 years earlier in patients with diabetes compared to those without diabetes15

The gender gap


All too often women are being overlooked despite presenting with the symptoms of heart failure to their GPs. Keeping the symptoms of heart failure front of mind could mean more people are diagnosed early and heart failure medication can be initiated promptly.


Of those who were tested by their

GP, 75% were men and 25%

were women16



Women were almost twice

as likely to be misdiagnosed

than men16

  1. Taylor et al. (2017) The REFER (REFer for EchocaRdiogram) study: a prospective validation and health economic analysis of a clinical decision rule, NT-proBNP or their combination in the diagnosis of heart failure in primary care. Southampton (UK): NIHR Journals Library; 2017 Apr. PMID: 28445025.
  2. National Institute for Health and Care Excellence [NG106], 2020. Reducing inappropriate use of NT pro BNP: A Quality Improvement project. Available from: https://www.nice.org.uk/sharedlearning/reducing-inappropriate-use-of-nt-pro-bnp-a-quality-improvement-project [Last accessed: November 2022]
  3. National Institute for Health and Care Excellence, 2018. Chronic heart failure in adults: diagnosis and management [online] Available from: https://www.nice.org.uk/guidance/ng106/resources/chronic-heart-failure-in-adults-diagnosis-and-management-pdf-66141541311685 [Last accessed: November 2022]
  4. NHS England, National Cost Collection for the NHS, 2022. Available from: https://www.england.nhs.uk/costing-in-the-nhs/national-cost-collection/#ncc1819  [Last accessed: November 2022]
  5. Clare Taylor, et al. (2021) FASTer diagnosis: Time to BEAT heart failure BJGP Open 2021; 5 (3): BJGPO.2021.0006. DOI: 10.3399/BJGPO.2021.0006
  6. Roalfe et al. (2022) Long term trends in natriuretic peptide testing for heart failure in UK primary care: a cohort study. European Heart Journal, Volume 43, Issue 9, 1 Pages 881–891
  7. Bottle et al. (2018) Routes to diagnosis of heart failure: observational study using linked data in England. Heart. 104(7):600-605.
  8. Mueller, C.et al. (2019), Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail, 21: 715-731. https:// doi.org/10.1002/ejhf.1494
  9. Taylor et al. (2022) Natriuretic peptide level at heart failure diagnosis and risk of hospitalisation and death in England 2004–2018 Heart 2022;108:543-549
  10. Conrad N, Judge A, Tran J, et al. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet2018;391:572-80. doi:10.1016/ S0140-6736(17)32520-5 pmid:29174292)
  11. Buzzback online survey conducted on behalf of Roche Diagnostics. n=110 GPs and Nurses in Great Britain. Data on file (August 2022)
  12. Lang CC, Mancini DM Non-cardiac comorbidities in chronic heart failure Heart 2007;93:665-671
  13. European Society of Cardiology (2019) https://onlinelibrary.wiley.com/doi/10.1002/ejhf.1673
  14. The Lancet Diabetes & Endocrinology (2014) https://www.thelancet.com/journals/landia/article/PIIS2213-8587(14)70219-0/fulltext#:~:text=Of%20people%20with%20type%202,1%25%5D%20of%206137%20patients)
  15. Diabetes Care 2001;24(9):1614–1619
  16. Censuswide, Data from survey of 625 heart failure patients analysed for this report. Data le, accessed 11 August 2020
  17. Buzzback online survey conducted on behalf of Roche Diagnostics. n=110 GPs and Nurses in Great Britain. Data on file (August 2022).