How this fits in

International guidelines recommend natriuretic peptide (NP) testing in primary care to prioritise referral for heart failure (HF) diagnostic assessment. European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guidelines differ significantly in their recommended NP referral threshold. The current study found at the lower ESC threshold fewer HF diagnoses were missed but more referrals from primary care would be required. Healthcare systems need to balance the risk of a missed or delayed diagnosis for individual patients with capacity in diagnostic services. An NP level below both the ESC and NICE thresholds was reliable in ruling out HF.