N-terminal pro-B-type natriuretic peptide testing improves the management of patients with suspected acute heart failure: primary results of the Canadian prospective randomized multicenter IMPROVE-CHF study.

Abstract

BACKGROUND:

The diagnostic utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure has been documented. However, most of the data were derived from countries with high healthcare resource use, and randomized evidence for utility of NT-proBNP was lacking.

METHODS AND RESULTS:

We tested the hypothesis that NT-proBNP testing improves the management of patients presenting with dyspnea to emergency departments in Canada by prospectively comparing the clinical and economic impact of a randomized management strategy either guided by NT-proBNP results or without knowledge of NT-proBNP concentrations. Five hundred patients presenting with dyspnea to 7 emergency departments were studied. The median NT-proBNP level among the 230 subjects with a final diagnosis of heart failure was 3697 compared with 212 pg/mL in those without heart failure (P<0.00001). Knowledge of NT-proBNP results reduced the duration of ED visit by 21% (6.3 to 5.6 hours; P=0.031), the number of patients rehospitalized over 60 days by 35% (51 to 33; P=0.046), and direct medical costs of all ED visits, hospitalizations, and subsequent outpatient services (US $6129 to US $5180 per patient; P=0.023) over 60 days from enrollment. Adding NT-proBNP to clinical judgment enhanced the accuracy of a diagnosis; the area under the receiver-operating characteristic curve increased from 0.83 to 0.90 (P<0.00001).

CONCLUSIONS:

In a universal health coverage system mandating judicious use of healthcare resources, inclusion of NT-proBNP testing improves the management of patients presenting to emergency departments with dyspnea through improved diagnosis, cost savings, and improvement in selected outcomes.

• Authors: Gordon W Moe, Jonathan Howlett, James L Januzzi, Hanna Zowall, Canadian Multicenter Improved Management of Patients With Congestive Heart Failure (IMPROVE-CHF) Study Investigators
• Journal: Circulation (Circulation) Vol. 115 Issue 24 Pg. 3103-10 (Jun 19 2007) ISSN: 1524-4539 [Electronic] United States
• PMID: 17548729 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• N-terminal proatrial natriuretic peptide
• Protein Precursors
• Atrial Natriuretic Factor

Topics

• Acute Disease
• Adult
• Aged
• Aged, 80 and over
• Ambulatory Care (economics)
• Atrial Natriuretic Factor (blood)
• Biomarkers (blood)
• Canada
• Cost Savings
• Dyspnea (blood, diagnosis, drug therapy)
• Emergency Medical Services (economics)
• Female
• Health Expenditures
• Heart Failure (blood, diagnosis, economics, therapy)
• Humans
• Male
• Middle Aged
• National Health Programs (economics)
• Outcome Assessment, Health Care (economics)
• Patient Readmission (economics)
• Prospective Studies
• Protein Precursors (blood)