Abstract | BACKGROUND: METHODS: We conducted a prospective, randomized, controlled study of 452 patients who presented to the emergency department with acute dyspnea: 225 patients were randomly assigned to a diagnostic strategy involving the measurement of B-type natriuretic peptide levels with the use of a rapid bedside assay, and 227 were assessed in a standard manner. The time to discharge and the total cost of treatment were the primary end points. RESULTS: Base-line demographic and clinical characteristics were well matched between the two groups. The use of B-type natriuretic peptide levels reduced the need for hospitalization and intensive care; 75 percent of patients in the B-type natriuretic peptide group were hospitalized, as compared with 85 percent of patients in the control group (P=0.008), and 15 percent of those in the B-type natriuretic peptide group required intensive care, as compared with 24 percent of those in the control group (P=0.01). The median time to discharge was 8.0 days in the B-type natriuretic peptide group and 11.0 days in the control group (P=0.001). The mean total cost of treatment was 5,410 dollars (95 percent confidence interval, 4,516 dollars to 6,304 dollars) in the B-type natriuretic peptide group, as compared with 7,264 dollars (95 percent confidence interval, 6,301 dollars to 8,227 dollars) in the control group (P=0.006). The respective 30-day mortality rates were 10 percent and 12 percent (P=0.45). CONCLUSIONS: Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide in the emergency department improved the evaluation and treatment of patients with acute dyspnea and thereby reduced the time to discharge and the total cost of treatment.
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Authors | Christian Mueller, André Scholer, Kirsten Laule-Kilian, Benedict Martina, Christian Schindler, Peter Buser, Matthias Pfisterer, André P Perruchoud |
Journal | The New England journal of medicine
(N Engl J Med)
Vol. 350
Issue 7
Pg. 647-54
(Feb 12 2004)
ISSN: 1533-4406 [Electronic] United States |
PMID | 14960741
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright 2004 Massachusetts Medical Society |
Chemical References |
- Biomarkers
- Natriuretic Peptide, Brain
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Topics |
- Acute Disease
- Adult
- Aged
- Aged, 80 and over
- Biomarkers
(blood)
- Dyspnea
(blood, etiology, physiopathology)
- Emergency Service, Hospital
- Female
- Heart Failure
(blood, complications, diagnosis)
- Hospital Costs
- Hospitalization
(statistics & numerical data)
- Humans
- Length of Stay
- Male
- Middle Aged
- Natriuretic Peptide, Brain
(blood)
- Prospective Studies
- Single-Blind Method
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