Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

Simcha R. Meisel, James l. Januzzi, Margarita Medvedovski, Moshe Sharist, Michael Shochat, Jalal Ashkar, Pavel Peschansky, Shmuel Bar Haim, David S. Blondheim, Michael Glikson, Avraham Shotan

Research output: Contribution to journalArticlepeer-review

Abstract

Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level is useful to diagnose or exclude acutely decompensated heart failure (ADHF) in dyspnoeic patients presenting to the emergency department (ED). To evaluate the impact of ED NT-proBNP testing on admission, length of stay (LOS), discharge diagnosis and long-term outcome. Dyspnoeic patients were randomized in the ED to NT-proBNP testing. Admission and discharge diagnoses, and outcomes were examined. During 17 months, 470 patients were enrolled and followed for 2.0±1.3 years. ADHF likelihood, determined at study conclusion by validated criteria, established ADHF diagnosis as unlikely in 86 (17%), possible in 120 (24%), and likely in 293 (59%) patients. The respective admission rates in these subgroups were 80, 91, and 96%, regardless of blinding, and 61.9% of blinded vs. 74.5% of unblinded ADHF-likely patients were correctly diagnosed at discharge (p=0.029), with similar LOS. 2-year mortality within subgroups was unaffected by test, but was lower in ADHF-likely patients with NT-proBNP levels below median (5000 pg/ml) compared with those above median (p=0.002). Incidence of recurrent cardiac events tracked NT-proBNP levels. ED NT-proBNP testing did not affect admission, LOS, 2-year survival, or recurrent cardiac events among study patients but improved diagnosis at discharge, and allowed risk stratification even within the ADHF-likely group.

Original languageEnglish
Pages (from-to)99-108
Number of pages10
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume1
Issue number2
DOIs
StatePublished - Jun 2012
Externally publishedYes

Keywords

  • Acute heart failure
  • NT-proBNP
  • diagnosis
  • dyspnoea

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