| Authors |
| Mueller C, Scholer A, Laule-Kilian K, et al |
| Title |
| Use of B-Type Natriuretic Peptide in the Evaluation and Management of Acute Dyspnea |
| References |
| N Engl J Med 2004;350:647-54 |
| Background |
| Timely and accurate diagnosis of heart failure in patients presenting with acute dyspnea is challenging and impacts the time to which appropriate therapy is started. With volume expansion and pressure overload, cardiac ventricles release B-Type natriuretic peptides (BNP) and have been noted to be elevated in left ventricular dysfunction patients. |
| Purpose |
| To determine if using BNP levels in patients who present to the emergency department with acute dyspnea improves evaluation, time to discharge and cost of treatment as compared to usual care. |
| Design |
- Randomized, prospective, controlled trial
- 452 adult patients who presented to emergency department with acute dyspnea (not trauma related) as the primary symptom
|
| Exclusion Criteria |
- Serum creatinine >250 µmol/L, patients in cardiogenic shock or early transfer to another hospital
|
| Follow-Up |
| 30 days |
| Treatment Regimen |
BNP level measured group vs. control group (treated according to usual care and guidelines)
- One rapid beside BNP measurement completed for patients randomized to this group (not measured serially)
- Considered in conjunction with other clinical information, if level:
- <100 pg/mL, HF diagnosis unlikely
- 100-500 pg/mL, clinical judgement (rule out stable baseline LV dysfunction and other conditions as cause for dyspnea)
- >500 pg/mL, HF diagnosis most likely – rapid treatment with diuretics, NTG, ACE inhibitors and morphine
|
| Results |
|
Primary Endpoints
Time to discharge (median): 8 days (BNP) vs. 11 days (control); p=0.001
Total cost of treatment (median): $5410 (B-type NP) vs. $7264 (control); p=0.006.
Secondary Endpoints (see study for complete list)
| Outcome |
BNP
n = 225 |
Control
n = 227 |
p |
| Time to treatment (min) |
63 |
90 |
0.03 |
| Hospitalization |
75% |
85% |
0.008 |
| Required intensive care |
15% |
24% |
0.01 |
| Death in-hospital |
6% |
9% |
0.21 |
| Death by 30 days |
10% |
12% |
0.45 |
- COPD exacerbation was the most common diagnosis of acute dyspnea in the B-type NP group (23%) vs. the control group (11%), p=0.001
|
| Summary |
| The use of B-type natriuretic peptide levels in patients presenting with acute dyspnea significantly decreases time to HF treatment, need for hospitalization and intensive care, and ultimately reduces the time to discharge and total cost of treatment. |