Should B-Type Natriuretic Peptide Be Measured Routinely to Guide the Diagnosis and Management of Chronic Heart Failure?

erhaps more than in any other cardiovascular disorder, the diagnosis and treatment of heart failure rely heavily on the scholarship, skills, and judgment of the practicing physician. Proper management of this syndrome requires clinicians to integrate elements of the history, physical examination, and laboratory evaluations together with knowledge of multiple pharmacological and nonpharmacological treatments in an attempt to produce unpredictable degrees of improvement in patients who have a disabling and inexorably progressive disease. There is no diagnostic test for heart failure, and most therapies for the disorder need to be individually titrated, often with the intent of reproducing the treatment strategies used in clinical trials without any means of demonstrating a prognostic benefit in individual patients. Because of these challenges, the diagnosis of heart failure is frequently missed, and useful treatments for heart failure are commonly underutilized. The situation is complicated by the fact that the vast majority of patients with heart failure are managed by primary care physicians and not by cardiologists.