Brain natriuretic peptide in the evaluation of emergency department dyspnea: is there a role?

TitleBrain natriuretic peptide in the evaluation of emergency department dyspnea: is there a role?
Publication TypeJournal Article
Year of Publication2012
AuthorsCarpenter CR, Keim SM, Worster A, Rosen P
Corporate AuthorsBEEM(Best Evidence in Emergency Medicine)
JournalJ Emerg Med
Volume42
Issue2
Pagination197-205
Date Published2012 Feb
ISSN Number0736-4679
KeywordsAcute Disease, Aged, 80 and over, Biological Markers, Dyspnea, Emergency Medicine, Emergency Service, Hospital, Heart Failure, Hospital Costs, Humans, Intensive Care Units, Length of Stay, Logistic Models, Male, Natriuretic Peptide, Brain, Patient Discharge, Prospective Studies
Abstract

<p><b>BACKGROUND: </b>Acute decompensated congestive heart failure (ADCHF) is a common etiology of dyspnea in emergency department (ED) patients. Delayed diagnosis of ADCHF increases morbidity and mortality. Two cardiac biomarkers, N-terminal-pro brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) have demonstrated excellent sensitivity in diagnostic accuracy studies, but the clinical impact on patient-oriented outcomes of these tests remains in question.</p>
<p><b>CLINICAL QUESTION: </b>Does emergency physician awareness of BNP or NT-proBNP level improve ADCHF patient-important outcomes including ED length of stay, hospital length of stay, cardiovascular mortality, or overall health care costs?</p>
<p><b>EVIDENCE REVIEW: </b>Five trials have randomized clinicians to either knowledge of or no knowledge of ADCHF biomarker levels in ED patients with dyspnea and some suspicion for heart failure. In assessing patient-oriented outcomes such as length-of-stay, return visits, and overall health care costs, the randomized controlled trials fail to provide evidence of unequivocal benefit to patients, clinicians, or society.</p>
<p><b>CONCLUSION: </b>Clinician awareness of BNP or NT-proBNP levels in ED dyspnea patients does not necessarily improve outcomes. Future ADCHF biomarker trials must assess patient-oriented outcomes in conjunction with validated risk-stratification instruments.</p>

DOI10.1016/j.jemermed.2011.07.014
Alternate JournalJ Emerg Med
PubMed ID22123173
PubMed Central IDPMC3278503
Grant ListKM1 CA156708-01 / CA / NCI NIH HHS / United States
UL1 RR024992 / RR / NCRR NIH HHS / United States
Faculty Reference: 
Samuel M. Keim, MD, MSc
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