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B-Type Natriuretic Peptide Testing, Clinical Outcomes, and Health Services Use in Emergency Department Patients With Dyspnea
A Randomized Trial
- Hans-Gerhard Schneider, MBBS, MD;
- Louisa Lam, MPH;
- Amaali Lokuge, MBBS;
- Henry Krum, MBBS, PhD;
- Matthew T. Naughton, MBBS;
- Pieter De Villiers Smit, MBBS;
- Adam Bystrzycki, MBBS;
- David Eccleston, MBBS, PhD;
- Jacob Federman, MBBS;
- Genevieve Flannery, MBBS; and
- Peter Cameron, MBBS, MD
Abstract
Background: B-type natriuretic peptide (BNP) is used to diagnose heart failure, but the effects of using the test on all dyspneic patients is uncertain.
Objective: To assess whether BNP testing alters clinical outcomes and health services use of acutely dyspneic patients.
Design: 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.
Setting: 2 Australian teaching hospital emergency departments.
Patients: 612 consecutive patients who presented with acute severe dyspnea from August 2005 to March 2007.
Intervention: BNP testing (n = 306) or no testing (n = 306).
Measurements: Admission rates, length of stay, and emergency department medications (primary outcomes); mortality and readmission rates (secondary outcomes).
Results: 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.
Limitation: Most patients were very short of breath and required hospitalization; the findings might not apply for evaluating patients with milder degrees of breathlessness.
Conclusion: 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.
Primary Funding Source: Janssen-Cilag.
Article and Author Information
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Grant Support: By an unrestricted educational grant from Janssen-Cilag to Drs. Schneider and Krum.
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Potential Financial Conflicts of Interest: Grants received: H.G. Schneider (Janssen-Cilag), H. Krum (Janssen-Cilag).
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Reproducible Research Statement: Study protocol: Available from Dr. Schneider (e-mail, schneiderh{at}alfred.org.au). Statistical code and data set: Not available.
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Requests for Single Reprints: Hans-Gerhard Schneider, MBBS, MD, Alfred Pathology Service, PO Box 315, Commercial Road, Prahran, Victoria 3181, Australia; e-mail, schneiderh{at}alfred.org.au.
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Current Author Addresses: Dr. Schneider: Alfred Pathology Service, Alfred Health, PO Box 315, Commercial Road, Prahran, Victoria 3181, Australia.
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Drs. Lam, Krum, and Cameron: Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, 89 Commercial Road, Melbourne, Victoria 3004, Australia.
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Drs. Lokuge, De Villiers Smit, and Bystrzycki: Emergency Department, Alfred Health, PO Box 315, Commercial Road, Prahran, Victoria 3181, Australia.
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Dr. Naughton: Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, PO Box 315, Commercial Road, Prahran, Victoria 3181, Australia.
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Dr. Eccleston: Department of Cardiology, Royal Melbourne Hospital, Gratton Street, Parkville, Victoria 3052, Australia.
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Dr. Federman: Cardiology Department, Alfred Health, PO Box 315, Commercial Road, Prahran, Victoria 3181, Australia.
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Dr. Flannery: Professional General Medicine Unit, Alfred Health, PO Box 315, Commercial Road, Prahran, Victoria 3181, Australia.
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Author Contributions: Conception and design: H.G. Schneider, L. Lam, H. Krum, M.T. Naughton, A. Bystrzycki, P. Cameron.
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Analysis and interpretation of the data: H.G. Schneider, L. Lam, A. Lokuge, H. Krum, M.T. Naughton, P. De Villiers Smit, A. Bystrzycki, D. Eccleston, J. Federman, G. Flannery, P. Cameron.
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Drafting of the article: H.G. Schneider, L. Lam, H. Krum, M.T. Naughton, P. De Villiers Smit, D. Eccleston, G. Flannery, P. Cameron.
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Critical revision of the article for important intellectual content: H.G. Schneider, L. Lam, H. Krum, M.T. Naughton, P. De Villiers Smit, A. Bystrzycki, D. Eccleston, J. Federman, G. Flannery, P. Cameron.
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Final approval of the article: H.G. Schneider, L. Lam, A. Lokuge, H. Krum, M.T. Naughton, P. De Villiers Smit, A. Bystrzycki, D. Eccleston, G. Flannery, P. Cameron.
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Provision of study materials or patients: H.G. Schneider, L. Lam, P. De Villiers Smit, A. Bystrzycki, D. Eccleston, P. Cameron.
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Statistical expertise: L. Lam, D. Eccleston.
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Obtaining of funding: H.G. Schneider, H. Krum, P. Cameron.
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Administrative, technical, or logistic support: H.G. Schneider, L. Lam, A. Lokuge, P. Cameron.
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Collection and assembly of data: H.G. Schneider, L. Lam, A. Lokuge, P. De Villiers Smit, D. Eccleston.
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ClinicalTrials.gov registration number: NCT00163709.
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