B-Type Natriuretic Peptide Testing, Clinical Outcomes, and Health Services Use in Emergency Department Patients With Dyspnea

Schneider, Helga; Lam, Louisa; Lokuge, Amaali; Krum, Henry; Naughton, Matthew T.; Smit, Pieter De Villiers; Bystrzycki, Adam; Eccleston, D.; Federman, Jacob; Flannery, Genevieve; Cameron, Peter

doi:10.7326/0003-4819-150-6-200903170-00004

Cited by 66 publications

(41 citation statements)

References 23 publications

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“…Despite a difference in admission rate among subgroups, probably reflecting symptom severity, we observed no difference in admission rate by blinding within subgroups. Hence, in the present setup, availability of test results did not affect the decision to admit these symptomatic patients, as observed also in the IMPROVE-CHF study 7 and by Schneider et al 14 Both these studies demonstrated similar admission rates to those in the present study, in contrast to a possible reduction reported in a recent relatively large meta-analysis. 15 This neutral finding could plausibly be the result of central laboratory testing involving a necessary turnaround time.…”

Section: Diagnosis Of Adhf In the Edcontrasting

confidence: 56%

Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

Meisel

Januzzi

Medvedovski

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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Background: Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level is useful to diagnose or exclude acutely decompensated heart failure (ADHF) in dyspnoeic patients presenting to the emergency department (ED). Aim: To evaluate the impact of ED NT-proBNP testing on admission, length of stay (LOS), discharge diagnosis and longterm outcome. Methods: Dyspnoeic patients were randomized in the ED to NT-proBNP testing. Admission and discharge diagnoses, and outcomes were examined. Results: During 17 months, 470 patients were enrolled and followed for 2.0±1.3 years. ADHF likelihood, determined at study conclusion by validated criteria, established ADHF diagnosis as unlikely in 86 (17%), possible in 120 (24%), and likely in 293 (59%) patients. The respective admission rates in these subgroups were 80, 91, and 96%, regardless of blinding, and 61.9% of blinded vs. 74.5% of unblinded ADHF-likely patients were correctly diagnosed at discharge (p=0.029), with similar LOS. 2-year mortality within subgroups was unaffected by test, but was lower in ADHF-likely patients with NTproBNP levels below median (5000 pg/ml) compared with those above median (p=0.002). Incidence of recurrent cardiac events tracked NT-proBNP levels. Conclusion: ED NT-proBNP testing did not affect admission, LOS, 2-year survival, or recurrent cardiac events among study patients but improved diagnosis at discharge, and allowed risk stratification even within the ADHF-likely group. (ClinicalTrials.gov#NCT00271128)

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Section: Diagnosis Of Adhf In the Edcontrasting

confidence: 56%

Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

Meisel

Januzzi

Medvedovski

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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“…14 -18 Mueller et al 24 showed that in Switzerland, patients who had BNP testing in the ED had earlier initiation of appropriate treatment, decreased hospital and intensive care unit admission rates, earlier discharge, and decreased cost of treatment. In contrast, the randomized controlled trial BNP in Shortness of Breath (SOB) study conducted in Australia by Schneider et al 25 showed that BNP testing in dyspneic patients presenting to the ED did not improve hospital admission rates, length of hospital stay, or management in the ED.…”

Section: Clinical Perspective On P 110mentioning

confidence: 73%

B-Type Natriuretic Peptide Testing and the Accuracy of Heart Failure Diagnosis in the Emergency Department

Lokuge

Lam

Cameron

et al. 2010

Circ: Heart Failure

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Background-It is often difficult to diagnose heart failure (HF) accurately in patients presenting with dyspnea to the emergency department (ED). This study assessed whether B-type natriuretic peptide (BNP) testing in these patients improved the accuracy of HF diagnosis. Methods and Results-Patients presenting to the Alfred and the Northern Hospital EDs with a chief complaint of dyspnea were enrolled prospectively from August 2005 to April 2007. Patients were randomly allocated to have BNP levels tested or not. The diagnostic gold standard for HF was determined by 1 cardiologist and 1 emergency or respiratory physician who, blinded to the BNP result, independently reviewed all available information. The ED diagnosis of HF in the non-BNP group showed a sensitivity, specificity, and accuracy of 65%, 92%, and 81%, respectively. The BNP group had a similar sensitivity, specificity, and accuracy of 66%, 90%, and 78%, respectively, for the diagnosis of HF in the ED. There was no significant difference between the BNP and non-BNP groups in any of the measures of diagnostic accuracy for HF. Conclusion-In the clinical setting of EDs, availability of BNP levels did not significantly improve the accuracy of a diagnosis of HF.

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“…This can expedite evaluation and initiation of appropriate treatment and may contribute to reduced costs and length of stay for those who require hospitalization (207,208). Routine use of BNP in all patients presenting with acute dyspnea is not recommended (209), especially when admission is highly likely in any event (209). In acute care settings such as an ED, the sensitivity of BNP or NTproBNP is substantially higher than its specificity, and its utility is greatest for ruling out heart failure as a cause of acute dyspnea in patients with a low to intermediate pretest probability of heart failure (210,211).…”

Section: Evaluation and Treatment Evaluationmentioning

confidence: 99%

An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

Parshall¹,

Schwartzstein²,

Adams³

et al. 2012

Am J Respir Crit Care Med

1,470

1,328

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B-Type Natriuretic Peptide Testing, Clinical Outcomes, and Health Services Use in Emergency Department Patients With Dyspnea

Abstract: Janssen-Cilag.

Cited by 66 publications

References 23 publications

Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

B-Type Natriuretic Peptide Testing and the Accuracy of Heart Failure Diagnosis in the Emergency Department

An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

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