Article

B-type natriuretic peptide testing, clinical outcomes, and health services use in emergency department patients with dyspnea: a randomized trial.

Alfred Health, Prahran, and Royal Melbourne Hospital, Parkville, Victoria, Australia.
Annals of internal medicine (Impact Factor: 16.1). 04/2009; 150(6):365-71.
Source: PubMed

ABSTRACT B-type natriuretic peptide (BNP) is used to diagnose heart failure, but the effects of using the test on all dyspneic patients is uncertain.
To assess whether BNP testing alters clinical outcomes and health services use of acutely dyspneic patients.
Randomized, single-blind study. Patients were assigned to a treatment group through randomized numbers in a sealed envelope. Patients were blinded to the intervention, but clinicians and those who assessed trial outcomes were not.
2 Australian teaching hospital emergency departments.
612 consecutive patients who presented with acute severe dyspnea from August 2005 to March 2007.
BNP testing (n = 306) or no testing (n = 306).
Admission rates, length of stay, and emergency department medications (primary outcomes); mortality and readmission rates (secondary outcomes).
There were no between-group differences in hospital admission rates (85.6% [BNP group] vs. 86.6% [control group]; difference, -1.0 percentage point [95% CI, -6.5 to 4.5 percentage points]; P = 0.73), length of admission (median, 4.4 days [interquartile range, 2 to 9 days] vs. 5.0 days [interquartile range, 2 to 9 days]; P = 0.94), or management of patients in the emergency department. Test discrimination was good (area under the receiver-operating characteristic curve, 0.87 [CI, 0.83 to 0.91]). Adverse events were not measured.
Most patients were very short of breath and required hospitalization; the findings might not apply for evaluating patients with milder degrees of breathlessness.
Measurement of BNP in all emergency department patients with severe shortness of breath had no apparent effects on clinical outcomes or use of health services. The findings do not support routine use of BNP testing in all severely dyspneic patients in the emergency department.
Janssen-Cilag.

0 Followers
 · 
112 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Das im Bereich der Notfallmedizin häufige Symptom Dyspnoe stellt eine diagnostische wie therapeutische Herausforderung dar. Eine Vielzahl an Differenzialdiagnosen ist zu berücksichtigen und zu überprüfen, doch bei Hinweisen auf eine Bedrohung quoad vitam wie auch bei rasch reversiblen Ursachen ist eine (Erst-)Behandlung möglichst ohne Zeitverzug einzuleiten. Aufgeführt werden die für eine initiale Einschätzung und Risikostratifizierung relevanten Aspekte, die sich aus anamnestischen Angaben, klinischem Eindruck und ersten, direkt verfügbaren Screeningtests ergeben. Ausführlich beschrieben wird das klinische wie das apparative diagnostische Instrumentarium, einschließlich der Durchführung und Interpretation. Eingegangen wird auf die Relevanz einzelner Methoden im jeweiligen klinischen Kontext und auf mögliche Fehlerquellen bzw. Limitationen. Ein möglicher Algorithmus für das Management von Dyspnoe im präklinischen Setting − vom ersten Kontakt bis zur Aufnahme bzw. bis zur Entlassung − wird graphisch wie schriftlich vorgestellt.
    02/2013; 108(1). DOI:10.1007/s00063-012-0170-6
  • [Show abstract] [Hide abstract]
    ABSTRACT: The measurement of natriuretic peptides (NPs), B-type NP or N-terminal pro-B-type NP, can be an important tool in the diagnosis of acute heart failure in patients presenting to an Emergency Department (ED) with acute dyspnea, according to international guidelines. Studies and subsequent meta-analyses are mixed on the absolute value of routine NP assessment of ED patients. However, levels of NPs are likely to be used also to guide treatment and to assess risk of adverse outcomes in other patients at risk of developing heart failure, including those with pulmonary embolism or diabetes, or receiving chemotherapy. Natriuretic peptide levels, like other biomarkers, can now be measured at the point of care (POC). We have reviewed the current status of NP measurement together with the potential contribution of POC measurement of NPs to clinical care delivery in the emergency and other settings. Several POC systems for measuring NP levels are now available: these produce test results within 15 minutes and appear sufficiently sensitive and robust to be used routinely in diagnostic evaluations. Point-of-care systems could be used to assess NP levels in the ED and community outpatient settings to monitor the risk of acute heart failure. Furthermore, the use of protocol-driven POC testing of NP within the time frame of a patient consultation in the ED may facilitate and accelerate the throughput and disposition of at-risk patients. Appropriately designed clinical trials will be needed to confirm these potential benefits. It is also important that processes of care delivery are redesigned to take full advantage of the faster turnaround times provided by POC technology.
    American heart journal 10/2013; 166(4):614-621.e1. DOI:10.1016/j.ahj.2013.06.012 · 4.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Acute heart failure is a leading reason for emergency department visits, hospital admissions, and readmissions. Despite the high rate of hospitalization for heart failure and the high resource burden attributable to acute heart failure, limitations of clinical decisions have been demonstrated. Risk stratification methods may provide guidance to clinicians who care for patients with acute heart failure syndromes, and may improve decision-making in emergent care when decisions must be made quickly and accurately. While many acute heart failure risk models have been developed in hospitalized cohorts to predict in-hospital mortality, there are fewer methods to enable prognostication broadly among all patients in a community-based setting. As validated predictive risk algorithms become increasingly accessible, they may be applied to select optimal therapies, determine how patients will be cared for in the emergency department, and improve decisions pertaining to patient disposition and follow-up.
    The Canadian journal of cardiology 03/2014; 30(3). DOI:10.1016/j.cjca.2014.01.001 · 3.94 Impact Factor

Full-text (2 Sources)

Download
59 Downloads
Available from
Jun 2, 2014