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

Christopher R. Carpenter, Samuel M. Keim, Andrew Worster, Peter Rosen

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Background: 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. Clinical Question: 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? Evidence Review: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)197-205
Number of pages9
JournalJournal of Emergency Medicine
Volume42
Issue number2
DOIs
StatePublished - Feb 1 2012

Keywords

  • congestive heart failure
  • cost-effectiveness
  • natriuretic peptide
  • outcomes

ASJC Scopus subject areas

  • Emergency Medicine

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