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Atrial fibrillation, a difficulty in the heart failure screening with natriuretic peptides
  1. Paulo Bettencourt1,3,
  2. Patrícia Lourenço2
  1. 1 Department of Medicine, Universidade do Porto Faculdade de Medicina, Porto, Portugal
  2. 2 Heart Failure Clinic, Department of Internal Medicine, Hospital São João, Porto, Portugal
  3. 3 Internal Medicine, Hospital CUF Porto, Porto, Porto
  1. Correspondence to Professor Paulo Bettencourt, Department of Medicine, Universidade do Porto Faculdade de Medicina, Porto 4200-319, Portugal; pbettfer{at}

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The burden of heart failure (HF) has long been recognised by the medical community; politics and population in general now begin to be aware of this major public health issue. One of the challenges when dealing with HF is the clear identification of patients with the condition. The detection of such patients is crucial since we have several interventions that can change the trajectory of the disease and lead to better survival and quality of life.

HF suspicion is based on typical signs and symptoms that are easily recognised by clinicians. Current recommendations strongly suggest that these patients perform basic tests (12-lead ECG; natriuretic peptide measurement) in order to exclude HF as the underlying cause of such clinical findings.

There is now robust and extensive evidence that natriuretic peptides can help clinicians in the diagnosis of acute HF. Even when physicians are uncertain on the mechanism of acute dyspnoea (pulmonary vs cardiac), the knowledge of natriuretic peptide levels gives crucial information. In ambulatory patients, the evidence is not so strong. There are a number of individual characteristics (gender, weight and age), comorbid conditions and medications that can affect the performance of natriuretic peptides in ambulatory patients with suspected HF. The value of natriuretic peptides in the diagnosis of HF has been established in patients with both preserved ejection …

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  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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