|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2004; 44:1328-1333, doi:10.1016/j.jacc.2004.06.015 © 2004 by the American College of Cardiology Foundation |
* University of California-San Diego, Veterans Affairs Medical Center, San Diego, California, USA
University of Pennsylvania, Philadelphia, Pennsylvania, USA
University of California at San Diego and Thornton Medical Center, San Diego, California, USA
University of Missouri–Kansas City School of Medicine, Truman Medical Center, Elmwood Hospital, and Edwards Hospitals, Kansas City, Missouri, USA
|| Henry Ford Hospital, Detroit, Michigan, USA
¶ The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
# Good Samaritan Hospital, Heart Failure Program at Midwest Heart Specialists, Downers Grove, Illinois, USA
** Medical College of Virginia, Richmond Veterans Affairs Medical Center, Richmond, Virginia, USA
Manuscript received February 12, 2004; revised manuscript received June 1, 2004, accepted June 8, 2004.
* Reprint requests and correspondence: Dr. Alan Maisel, VAMC Cardiology 111-A, 3350 La Jolla Village Drive, San Diego, California 92161, USA.
amaisel{at}ucsd.edu
OBJECTIVES: The purpose of this study was to examine the relationships among B-type natriuretic peptide (BNP) levels within the diagnostic range, perceived congestive heart failure (CHF) severity, clinical decision making, and outcomes of the CHF patients presenting to emergency department (ED).
BACKGROUND: Since BNP correlates with the presence of CHF, disease severity, and prognosis, we hypothesized that BNP levels in the diagnostic range offer value independent of physician decision making with regard to critical outcomes in emergency medicine.
METHODS: The Rapid Emergency Department Heart failure Outpatient Trial (REDHOT) study was a 10-center trial in which patients seen in the ED with shortness of breath were consented to have BNP levels drawn on arrival. Entrance criteria included a BNP level >100 pg/ml. Physicians were blinded to the actual BNP level and subsequent BNP measurements. Patients were followed up for 90 days after discharge.
RESULTS: Of the 464 patients, 90% were hospitalized. Two-thirds of patients were perceived to be New York Heart Association (NYHA) functional class III or IV. The BNP levels did not differ significantly between patients who were discharged home from the ED and those admitted (976 vs. 766, p = 0.6). Using logistic regression analysis, an ED doctor's intention to admit or discharge a patient had no influence on 90-day outcomes, while the BNP level was a strong predictor of 90-day outcome. Of admitted patients, 11% had BNP levels <200 pg/ml (66% of which were perceived NYHA functional class III or IV). The 90-day combined event rate (CHF visits or admissions and mortality) in the group of patients admitted with BNP <200 pg/ml and >200 pg/ml was 9% and 29%, respectively (p = 0.006).
CONCLUSIONS: In patients presenting to the ED with heart failure, there is a disconnect between the perceived severity of CHF by ED physicians and severity as determined by BNP levels. The BNP levels can predict future outcomes and thus may aid physicians in making triage decisions about whether to admit or discharge patients. Emerging clinical data will help further refine biomarker-guided outpatient therapeutic and monitoring strategies involving BNP.
| ||||||||||||||
Related Article
J. Am. Coll. Cardiol. 2004 44: 1334-1336.
This article has been cited by other articles:
|
|
 |
|
  C. Ronco, M. Haapio, A. A. House, N. Anavekar, and R. Bellomo Cardiorenal Syndrome J. Am. Coll. Cardiol., November 4, 2008; 52(19): 1527 - 1539. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Maisel, W. F. Peacock, N. McMullin, R. Jessie, G. C. Fonarow, J. Wynne, and R. M. Mills Timing of Immunoreactive B-Type Natriuretic Peptide Levels and Treatment Delay in Acute Decompensated Heart Failure: An ADHERE (Acute Decompensated Heart Failure National Registry) Analysis J. Am. Coll. Cardiol., August 12, 2008; 52(7): 534 - 540. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Daniels, G. A. Laughlin, P. Clopton, A. S. Maisel, and E. Barrett-Connor Minimally Elevated Cardiac Troponin T and Elevated N-Terminal Pro-B-Type Natriuretic Peptide Predict Mortality in Older Adults: Results From the Rancho Bernardo Study J. Am. Coll. Cardiol., August 5, 2008; 52(6): 450 - 459. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A L Baggish, D M Lloyd-Jones, J Blatt, A M Richards, J Lainchbury, M O'Donoghue, R Sakhuja, A A Chen, and J L Januzzi A clinical and biochemical score for mortality prediction in patients with acute dyspnoea: derivation, validation and incorporation into a bedside programme Heart, August 1, 2008; 94(8): 1032 - 1037. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W Yip B-type natriuretic peptide: a treatment, not a diagnostic marker Heart, May 1, 2008; 94(5): 542 - 544. [Full Text] [PDF]
|
|
|
|
 |
|
 J. N. Kirkpatrick, S. N. Ghani, and K. T. Spencer Hand carried echocardiography screening for LV systolic dysfunction in a pulmonary function laboratory Eur J Echocardiogr, May 1, 2008; 9(3): 381 - 383. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Green, A. Martinez-Rumayor, S. A. Gregory, A. L. Baggish, M. L. O'Donoghue, J. A. Green, K. B. Lewandrowski, and J. L. Januzzi Jr Clinical Uncertainty, Diagnostic Accuracy, and Outcomes in Emergency Department Patients Presenting With Dyspnea Arch Intern Med, April 14, 2008; 168(7): 741 - 748. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Daniels and A. S. Maisel Natriuretic Peptides J. Am. Coll. Cardiol., December 18, 2007; 50(25): 2357 - 2368. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Maisel Biomarkers in Heart Failure: Does Prognostic Utility Translate to Clinical Futility? J. Am. Coll. Cardiol., September 11, 2007; 50(11): 1061 - 1063. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Breidthardt, K. Laule, A.-H. Strohmeyer, C. Schindler, S. Meier, M. Fischer, A. Scholer, M. Noveanu, M. Christ, A. P. Perruchoud, et al. Medical and Economic Long-term Effects of B-Type Natriuretic Peptide Testing in Patients with Acute Dyspnea Clin. Chem., August 1, 2007; 53(8): 1415 - 1422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. C. Fonarow, W. F. Peacock, C. O. Phillips, M. M. Givertz, M. Lopatin, and for the ADHERE Scientific Advisory Committee and I Admission B-Type Natriuretic Peptide Levels and In-Hospital Mortality in Acute Decompensated Heart Failure J. Am. Coll. Cardiol., May 15, 2007; 49(19): 1943 - 1950. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. H. Zou, A. J. O'Malley, and L. Mauri Receiver-Operating Characteristic Analysis for Evaluating Diagnostic Tests and Predictive Models Circulation, February 6, 2007; 115(5): 654 - 657. [Full Text] [PDF]
|
|
|
|
|
|
T. H. Le Jemtel, M. Padeletti, and S. Jelic Diagnostic and Therapeutic Challenges in Patients With Coexistent Chronic Obstructive Pulmonary Disease and Chronic Heart Failure J. Am. Coll. Cardiol., January 16, 2007; 49(2): 171 - 180. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Abroug, L. Ouanes-Besbes, N. Nciri, N. Sellami, F. Addad, K. B. Hamda, A. B. Amor, M. F. Najjar, and J. Knani Association of Left-Heart Dysfunction with Severe Exacerbation of Chronic Obstructive Pulmonary Disease: Diagnostic Performance of Cardiac Biomarkers Am. J. Respir. Crit. Care Med., November 1, 2006; 174(9): 990 - 996. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Price, A. K. Thomas, M. Grenier, B. W. Eidem, E. O. Smith, S. W. Denfield, J. A. Towbin, and W. J. Dreyer B-Type Natriuretic Peptide Predicts Adverse Cardiovascular Events in Pediatric Outpatients With Chronic Left Ventricular Systolic Dysfunction Circulation, September 5, 2006; 114(10): 1063 - 1069. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Jaffe, L. Babuin, and F. S. Apple Biomarkers in Acute Cardiac Disease: The Present and the Future J. Am. Coll. Cardiol., July 4, 2006; 48(1): 1 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. V. St. Peter, G. G. Hartley, M. M. Murakami, and F. S. Apple B-Type Natriuretic Peptide (BNP) and N-Terminal Pro-BNP in Obese Patients without Heart Failure: Relationship to Body Mass Index and Gastric Bypass Surgery Clin. Chem., April 1, 2006; 52(4): 680 - 685. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. van Kimmenade, F. van Dielen, J. Bakker, J. Nijhuis, H. Crijns, W. Buurman, M. van Dieijen-Visser, J.-W. Greve, and Y. Pinto Is Brain Natriuretic Peptide Production Decreased in Obese Subjects? J. Am. Coll. Cardiol., February 21, 2006; 47(4): 886 - 887. [Full Text] [PDF]
|
|
|
|
|
|
J. L. Januzzi Jr, R. Sakhuja, M. O'Donoghue, A. L. Baggish, S. Anwaruddin, C. U. Chae, R. Cameron, D. G. Krauser, R. Tung, C. A. Camargo Jr, et al. Utility of amino-terminal pro-brain natriuretic Peptide testing for prediction of 1-year mortality in patients with dyspnea treated in the emergency department. Arch Intern Med, February 13, 2006; 166(3): 315 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Januzzi, R. van Kimmenade, J. Lainchbury, A. Bayes-Genis, J. Ordonez-Llanos, M. Santalo-Bel, Y. M. Pinto, and M. Richards NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: The International Collaborative of NT-proBNP Study Eur. Heart J., February 1, 2006; 27(3): 330 - 337. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Maisel The Coming of Age of Natriuretic Peptides: The Emperor Does Have Clothes! J. Am. Coll. Cardiol., January 3, 2006; 47(1): 61 - 64. [Full Text] [PDF]
|
|
|
|
|
|
M. Gheorghiade, F. Zannad, G. Sopko, L. Klein, I. L. Pina, M. A. Konstam, B. M. Massie, E. Roland, S. Targum, S. P. Collins, et al. Acute Heart Failure Syndromes: Current State and Framework for Future Research Circulation, December 20, 2005; 112(25): 3958 - 3968. [Full Text] [PDF]
|
|
|
|
|
|
G. S. Ginsburg, M. P. Donahue, and L. K. Newby Prospects for Personalized Cardiovascular Medicine: The Impact of Genomics J. Am. Coll. Cardiol., November 1, 2005; 46(9): 1615 - 1627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Mockel, R. Muller, J. O. Vollert, C. Muller, A. Carl, D. Peetz, F. Post, J. K. Kohse, and K. J. Lackner Role of N-Terminal Pro-B-Type Natriuretic Peptide in Risk Stratification in Patients Presenting in the Emergency Room Clin. Chem., September 1, 2005; 51(9): 1624 - 1631. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Does BNP Testing Beat Clinical Assessment for Predicting CHF Outcomes? Journal Watch Emergency Medicine, November 24, 2004; 2004(1124): 7 - 7. [Full Text]
|
|
|
|
 |
|
 BNP Testing for Heart Failure Triage in the ED? Journal Watch Cardiology, November 5, 2004; 2004(1105): 6 - 6. [Full Text]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
