Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea.

Abstract

BACKGROUND:

B-type natriuretic peptide levels are higher in patients with congestive heart failure than in patients with dyspnea from other causes.

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.

• 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)
• Copyright: Copyright 2004 Massachusetts Medical Society

Chemical References

• Biomarkers
• Natriuretic Peptide, Brain

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