N-terminal pro–brain natriuretic peptide testing in the emergency department: Beneficial effects on hospitalization, costs, and outcome - 09/08/11
, Ewout W. Steyerberg, PhD b, Frans Boomsma, PhD a, Jan L.C.M. van Saase, MD, PhD a, Jaap W. Deckers, MD, PhD c, Henk C. Hoogsteden, MD, PhD d, Jan Lindemans, PhD e, Anton H. van den Meiracker, MD, PhD a, ⁎ Résumé |
Background |
N-terminal pro–brain natriuretic peptide (NT-proBNP) is an established biomarker for heart failure. Assessment of this biomarker in patients with acute dyspnea presenting to the emergency department (ED) may aid diagnostic decision-making, resulting in improved patient care and reduced costs.
Methods |
In a prospective clinical trial, patients presenting with acute dyspnea to the ED of the Erasmus Medical College, Rotterdam, the Netherlands, were randomized for either rapid measurement or no measurement of NT-proBNP. For ruling out heart failure, cutoff values of 93 pg/mL in male and 144 pg/mL in female patients were used, and for ruling in heart failure, a cutoff value of 1,017 pg/mL was used. Time to discharge from the hospital and costs related to hospital admission were primary end points. Bootstrap analysis was used for comparison of costs and 30-day mortality between the NT-proBNP and control group.
Results |
A total of 477 patients (54% male) was enrolled. The mean age was 59 years, with 44% of patients having a history of cardiac disease. Median time to discharge from the hospital was 1.9 days (interquartile range [IQR], 0.12-8.4 days) in the NT-proBNP group (n = 241) compared with 3.9 days (IQR, 0.16-11.0 days) in the control group (n = 236) (P = .04). Introduction of NT-proBNP testing resulted in a trend toward reduction in costs related to hospital admission and diagnostic investigations of $1,364 per patient (95% CI $−246 to $3,215), whereas 30-day mortality was similar (15 patients in the NT-proBNP and 18 patients in the control group).
Conclusions |
Introduction of NT-proBNP testing for heart failure in the ED setting reduces the time to discharge and is associated with a trend toward cost reduction.
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| This research project was funded by a grant of the Erasmus MC Medical Research Advisory Committee (Mrace). |
Vol 156 - N° 1
P. 71-77 - juillet 2008 Retour au numéro
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