Clinical InvestigationCongestive Heart FailureHow obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure: Results from the Breathing Not Properly Multinational Study☆
Section snippets
Study population
The Breathing Not Properly Multinational Study was an international, 7-site (5 in the United States, 1 in France, and 1 in Norway), prospective study. Study design and main results have been published elsewhere.16 A total of 1586 patients were enrolled from April 1999 to December 2000. The study was approved by the institutional review boards of participating study centers, and written informed consent was obtained from all participants. To be eligible for the study, patients had to have
Results
The baseline characteristics of the entire Breathing Not Properly Multinational Study cohort have previously been reported.16 Among the 1368 patients with valid height and weight data, 526 were lean (BMI <25), 595 were overweight or obese (25 ≤ BMI < 35), and 247 were severely or morbidly obese (BMI ≥35). The range in BMI was 12.9 to 74.4, with a mean BMI for the population of 28.7 ± 8.3. The mean weight and BMI for patients within each subgroup is shown in Table I and did not vary among those
Discussion
Heart failure is a difficult diagnosis to make in the ED or urgent care setting.16, 24 Classic signs and symptoms are not always present. This is especially true in obese patients, whose body habitus may mask signs of edema and may muffle the heart and lung sounds during auscultation. For example, in our study, patients with higher BMIs were less likely to have documented murmurs or rales and were not as likely to have visible elevation of jugular venous pressure. History also can be less
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Triage devices and meters and some financial support were provided by Biosite, San Diego, CA. Drs Nowak, Hollander, McCullough, and Maisel, and P Clopton have served as consultants and received research support from Biosite.