BNP / NT-proBNP (natriuretic peptides)

Pick Ordered or Not ordered to see the note.

Indicated when

• —Suspected heart failure in a patient with dyspnea, orthopnea, edema, or reduced exercise tolerance, where a natriuretic peptide has excellent ability to rule out acute heart failure at recommended lower thresholds [1]; this is also the condition under which NT-proBNP is OHIP-insured in Ontario [2]

Not indicated when

• —General cardiovascular or wellness screening in a person without symptoms suggestive of heart failure

Why not

In the validated context of suspected heart failure, BNP/NT-proBNP is a good test; the concern is ordering it outside that context, as a general wellness or screening marker, where its performance and interpretation haven't been established and a result has no validated action attached to it.

Better first step

If there are no symptoms suggestive of heart failure (dyspnea, orthopnea, edema, reduced exercise tolerance), a natriuretic peptide isn't the right test to order; if those symptoms are present, ordering it is itself the appropriate first step [1].

Typical ND rationale

An ND may recommend BNP or NT-proBNP testing when a patient has breathlessness, fatigue, or swelling, reasoning that it can help identify or rule out a heart-related cause before further workup.

Ontario coverage & CONO orderability

OHIP status

insured_conditional

NT-proBNP (L344) is clinically indicated and insured only in clients with suspected heart failure under the 2026 Schedule update (INFOBulletin 260310); it is not funded as a general or wellness screening test [2]. Insured when ordered by a physician, midwife, or NP who has clinically assessed the patient; the same test ordered by an ND is not insured and is billed privately (Reg. 552 s.22(1); SOB-LS 2026 preamble). This session confirmed the restriction for NT-proBNP by name only; the standard BNP assay's own coverage code and any restriction text were not separately confirmed (see evidence_notes).

CONO orderable

Yes — CONO list #95

CONO list item 95, blood: 'Natriuretic Peptide – Brain (BNP).' The CONO list does not separately name NT-proBNP; only the BNP entry was found.

Linked conditions

• chf ↗
• tired ↗

Counselling script

“Without symptoms like breathlessness, swelling, or a drop in your usual exercise tolerance, BNP or NT-proBNP isn't a test I'd add today; it's validated for ruling heart failure in or out in people who do have those symptoms. If those symptoms come up, it's exactly the right test to check.”

Revisit if

• —New dyspnea, orthopnea, leg edema, or reduced exercise tolerance
• —Known heart failure with a change in symptoms, for the treating clinician to reassess

References

1. [1]NICE Guideline Development Group for Acute Heart Failure (Roberts et al., BMJ) (2015). The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting. linkolder guidelineAt recommended lower thresholds, BNP and NT-proBNP have excellent sensitivity and negative predictive value for excluding acute heart failure
2. [2]Ontario Ministry of Health (2026). INFOBulletin 260310: Update: 2026-27 schedule of benefits for laboratory services. linkNT-proBNP (L344) is clinically indicated and insured only in clients with suspected heart failure
3. [3]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkCommunity lab tests are insured only when ordered under the Schedule by an authorized prescriber
4. [4]Government of Ontario (e-Laws) (2026). Health Insurance Act, R.R.O. 1990, Reg. 552: General, s. 22 (insured laboratory services). linkA lab test is insured only when ordered by a physician, midwife, or NP who has clinically assessed the patient
5. [5]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTests ordered by anyone other than an authorized provider, including NDs, are not insured services