Point-of-Care NT-proBNP Testing: Accelerating Heart Failure Diagnosis

In the 2026 landscape, and considering the potential consequences of a delayed heart failure diagnosis, could you elaborate on why the early identification of heart failure is so critical?

The early diagnosis of any disease is important, relevant, and critical, but this is particularly so in conditions like the syndrome of heart failure, which is associated with hospital admissions, hospital re-admissions, and death. So if we look at the data and we understand that the mortality of heart failure at five years is the same or worse than cancer, we should be doing the diagnosis as fast as we do with cancer. And at the present time for cancer, in 30 days you get, when you have the suspicion, you get the imaging, the PET CT scan, you get the biopsy, the molecular diagnosis, and you start treatment. 30 days in heart failure, we just need natriuretic peptide and then echo and we are failing. So there is something wrong in the pathway that we're following for diagnosis. And we need to expedite diagnosis. And that's something that we have to do as a society, as a community for the good of our patients.

How can the measurement of NT-proBNP in primary care settings for patients presenting with signs and symptoms of heart failure support an earlier diagnosis?

Heart failure is a clinical syndrome. And as a clinical syndrome, it has a number of signs and symptoms. These signs and symptoms at the beginning are not so obvious to diagnose. The patient that starts with heart failure may start with fatigue or progressive dyspnea and edema, but it's not so easy to make a diagnosis if the patient is obese, or has COPD, or has other comorbidities. So we need to support our clinical criteria with objective measures and natriuretic peptides are objective measures that give us an indication of the suffering of the myocardium. So, for example, I was in my clinic last week and this patient came with palpitations. I did an ECG. It was atrial fibrillation. But the patient said: "I have a little bit of fatigue, what's going on, Doctor?" So in addition to the atrial fibrillation, I immediately measured NT-proBNP and it was 750 pg/mL. So this is not atrial fibrillation alone. It's a patient with atrial fibrillation and heart failure and we need to treat both. So we need to control the arrhythmia and we need to do an echo to confirm the phenotype and to start treating as soon as possible.

How does point-of-care NT-proBNP testing bring clinical value to the primary care setting?

It is very important to make an early diagnosis because once we have a diagnosis, we start treatment and we have drugs and we have devices, but particularly in HFpEF we have SGLT2 inhibitors, we have MRAs and we have GLP-1 drugs that we can start as soon as we have the diagnosis. So what if you are in your clinic, you have this suspicion and you order an NT-proBNP, then the patient needs to go to the lab, get the blood work and return one week, two weeks, one month later. This is not convenient. If you have point-of-care testing and you can, in the same visit, have the suspicion, with a finger prick get a measurement of your NT-proBNP, and in 10 minutes have the result. This patient can go home with the prescription of the drug and the likelihood that this patient is admitted to a hospital goes down and, particularly, this patient's quality of life improves. So this is in the benefit of our patients.

Could you briefly describe the FIND-HF study design and share your perspective on how its findings might impact future clinical practice?

The FIND-HF study tries to demonstrate that the early use and measurement of natriuretic peptides, when there is a clinical suspicion, is positive. This study will randomize patients with suspicion of heart failure: one arm to standard of care, the other to education on point-of-care NT-proBNP testing. If NT-proBNP is above a threshold, medication will be initiated and the patient will be visited at eight weeks. We want to see, at eight weeks, the diagnosis rate, how many patients have been diagnosed, and eventually we want to demonstrate that as soon as eight weeks we already have differences in clinical outcomes, quality of life, hospitalizations, and eventually deaths. It is a short period of time and it just aims to change the pathway. This is an implementation trial. We do not want to promote the use of one drug or another. We just want to promote guideline-directed medical therapy, but do it faster, expediting to a very quick initiation.

What is the roadmap for expanding NT-proBNP point-of-care testing in primary care? If you could give one piece of advice to policymakers regarding system design, and one to clinicians regarding practical implementation, what would those be?

Natriuretic peptides started in the hospital; now they are in the community. In the community they are used, but we are still slow, as we said before, in making the diagnosis. So we need to convince policymakers and physicians. First, policymakers: by implementing NT-proBNP point-of-care testing, we are going to reduce the number of visits because two visits are compressed into one, and we are very likely going to reduce the number of hospitalizations. And the same message is important for physicians. Physicians want to optimize their time. We have a shortage of doctors. We need to organize the care pathway of our chronic patients. And heart failure is one of the most important chronic diseases that we are facing. So it is the right time to optimize the pathway and the landscape of heart failure by making an earlier diagnosis and treating earlier. In my opinion, point-of-care NT-proBNP testing is probably the most scalable and ready-to-implement approach to achieve that.