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: 13.98). 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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: There is broad adoption of various cardiac and noncardiac biomarkers in clinical practices across North America for the diagnosis and management of heart failure. Like any clinical condition, there are several overall objectives in biomarker testing: to establish or refute a diagnosis of heart failure and/or cardiac dysfunction; to understand the underlying pathophysiologic processes that may warrant specific interventions; to determine the level of disease severity in a manner to triage medical decisions; to detect and potentially avoid adverse consequences as a result of therapeutic interventions; and to monitor responses to treatment. While at present no single biomarker can serve all of these objectives, the growing experience with cardiac-specific biomarkers, such as natriuretic peptide and cardiac troponin testing, has allowed clinicians to better identify those at heightened short- or long-term risk. It is clear that difficulty remains in translating research evidence into clinical practice. While studies demonstrate statistical differences in short- and long-term outcomes, there is still limited information on how such improvements can be achieved solely based on current therapeutic options. Meanwhile, many commonly ordered tests have important prognostic information that can be overlooked, yet their changes may or may not affect prognosis. With healthcare cost on the rise in North America, clinical utility of biomarkers must demonstrate relative safety and potential incremental benefits to standard approaches.
    Biomarkers in Medicine 10/2009; 3(5):443-52. · 3.22 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Survivors of myocardial infarction (MI) are at increased risk of cardiac remodeling and heart failure. Activated neurohormones, including histamine, play a critical role in this regard. Blocking the activity of these neurohormones served as a rational choice in treatment of this disease. The study was designed to evaluate the effect of famotidine in management of patients with acute MI. The study was a multicenter randomized placebo controlled trial in which sixty patients were allocated into two groups. Group 1 (31 patients) received famotidine (40mg/d); Group 2 (29 patients) received placebo formula, in addition to the currently used drugs. All patients underwent initial echocardiographic evaluation at admission and 30 days after randomization along with measurement of N-terminal pro-Brain Natriuretic Peptide (Nt-proBNP) levels. Famotidine decreased the dilation of the left ventricle compared to placebo (P<0.05), with an absolute decrease in left ventricular ejection fraction (P<0.05). Famotidine treated patients also had a lower level of Nt-proBNP after completion of the study. In conclusion, famotidine appears to have a beneficial role in management of patients who survive myocardial infarction.
    Journal of Integrative and Experimental Medicine. 03/2012;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dyspnea is a common symptom in emergency medicine and represents a diagnostic and therapeutic challenge. A multitude of differential diagnoses must be considered and checked but where there are indications of a life-threatening situation and also by rapidly reversible causes an (initial) treatment must be initiated without delay. Initially implemented should be those aspects relevant for an initial assessment and risk stratification which result from anamnestic details, clinical symptoms and immediately available screening tests. This article describes in detail the clinical and diagnostic instrumental armamentarium including implementation and interpretation. Also discussed are the relevance of individual methods in the respective clinical context and possible sources of error and limitations. A possible algorithm for the management of dyspnea in a clinical setting, from initial contact to admission or release, is presented graphically and textually.
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 02/2013;

Full-text (2 Sources)

Available from
Jun 2, 2014