Gray zone BNP levels in heart failure patients in the emergency department: Results from the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) multicenter study

Brenden, Cynthia K.; Hollander, Judd E.; Guss, David; McCullough, Peter A.; Nowak, Richard; Green, Gary; Saltzberg, Mitchell; Ellison, Stefanie R.; Bhalla, Meenakshi Awasthi; Bhalla, Vikas; Clopton, Paul; Jesse, Robert; Maisel, Alan S.; for the REDHOT Investigators,

doi:10.1016/j.ahj.2005.10.017

« Previous Next »American Heart Journal
Volume 151, Issue 5 , Pages 1006-1011, May 2006

Gray zone BNP levels in heart failure patients in the emergency department: Results from the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) multicenter study

Cynthia K. Brenden, MD
- Hennepin County Medical Center, Minneapolis, MN
Judd E. Hollander, MD
- University of Pennsylvania, Philadelphia, PA
David Guss, MD
- University of California at San Diego and Thornton Medical Center, San Diego, CA
Peter A. McCullough, MD, MPH
- University of Missouri–Kansas City School of Medicine, Truman Medical Center, Elmwood Hospital, and Edwards Hospitals, Kansas City, MO
Richard Nowak, MD
- Henry Ford Hospital, Detroit, MI
Gary Green, MD
- The Johns Hopkins University School of Medicine, Baltimore, MD
Mitchell Saltzberg, MD
- Good Samaritan Hospital, Heart Failure Program at Midwest Heart Specialists, Downers Grove, IL
Stefanie R. Ellison, MD, FACEP
- University of Missouri–Kansas City School of Medicine, Truman Medical Center, Elmwood Hospital, and Edwards Hospitals, Kansas City, MO
Meenakshi Awasthi Bhalla, MD
- University of California–San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA
Vikas Bhalla, MD
- University of California–San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA
Paul Clopton, MS
- University of California–San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA
Robert Jesse, MD
- Medical College of Virginia, Richmond Veterans Affairs Medical Center, Richmond, VA
Alan S. Maisel, MD
- University of California–San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA
- Reprint requests: Alan Maisel MD, VASDHS Cardiology 9111-A, 3350 La Jolla Village Drive, San Diego, CA 92161.
for the REDHOT Investigators

Received 5 July 2005; accepted 13 October 2005.

Objectives

The study purpose was to examine “gray zone” B-type natriuretic peptide (BNP) levels (100-500 pg/mL) in terms of associated clinical factors, perceived severity, and outcomes in patients with established congestive heart failure (CHF).

Background

Although gray zone BNP levels may have diagnostic ambiguity, the implications of these levels in patients with an established diagnosis of CHF have not been examined.

Methods

REDHOT was a national prospective study in which 464 patients seen in the emergency department with dyspnea had BNP levels drawn. Entrance criteria included a BNP >100 pg/mL; however, physicians were blinded to the actual BNP level. Patients were followed up for 90 days.

Results

Thirty-three percent had gray zone BNP levels. There was no difference in perceived New York Heart Association class (P = .32) or admission rates (P = .76) between the gray zone and non–gray zone groups; 62% of patients with a gray zone BNP were identified as class III or IV CHF. Despite this perceived severity, the 90-day event rate was lower in the gray zone group (19.2% vs 32.9%, respectively, P = .002). Although patients in the gray zone had more symptoms of concomitant pulmonary disease, multivariate analysis could not demonstrate any variable that worsened the prognosis of patients with a gray zone BNP level.

Conclusions

In patients with established CHF, those with gray zone BNP levels have a better prognosis than those with non–gray zone levels despite being perceived by physicians as having New York Heart Association class III or IV CHF.