11
4.1.1. Initial Laboratory and Electrocardiographic Testing
COR LOE
Recommendations
1 B-NR 1. For patients presenting with HF, the specific cause of HF
should be explored using additional laboratory testing for
appropriate management.
1 C-EO 2. For patients who are diagnosed with HF, laboratory
evaluation should include complete blood count, urinalysis,
serum electrolytes, blood urea nitrogen, serum creatinine,
glucose, lipid profile, liver function tests, iron studies, and
thyroid-stimulating hormone to optimize management.
1 C-EO 3. For all patients presenting with HF, a 12-lead ECG should be
performed at the initial encounter to optimize management.
4.2. Use of Biomarkers for Prevention, Initial Diagnosis,
and Risk Stratification
COR LOE
Recommendations
1 A 1. In patients presenting with dyspnea, measurement of B-type
natriuretic peptide (BNP) or N-terminal prohormone of
B-type natriuretic peptide (NT-proBNP) is useful to support a
diagnosis or exclusion of HF.
1 A 2. In patients with chronic HF, measurements of BNP or NT-
proBNP levels are recommended for risk stratification.
1 A 3. In patients hospitalized for HF, measurement of BNP or
NT-proBNP levels at admission is recommended to establish
prognosis.
2a B-R
4. In patients at risk of developing HF, BNP or NT-proBNP–
based screening followed by team-based care, including
a cardiovascular specialist, can be useful to prevent the
development of LV dysfunction or new-onset HF.
2a B-NR
5. In patients hospitalized for HF, a predischarge BNP or NT-
proBNP level can be useful to inform the trajectory of the
patient and establish a postdischarge prognosis.
