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

      Affiliations

    • Hennepin County Medical Center, Minneapolis, MN
    • ,
  • Judd E. Hollander, MD

      Affiliations

    • University of Pennsylvania, Philadelphia, PA
    • ,
  • David Guss, MD

      Affiliations

    • University of California at San Diego and Thornton Medical Center, San Diego, CA
    • ,
  • Peter A. McCullough, MD, MPH

      Affiliations

    • University of Missouri–Kansas City School of Medicine, Truman Medical Center, Elmwood Hospital, and Edwards Hospitals, Kansas City, MO
    • ,
  • Richard Nowak, MD

      Affiliations

    • Henry Ford Hospital, Detroit, MI
    • ,
  • Gary Green, MD

      Affiliations

    • The Johns Hopkins University School of Medicine, Baltimore, MD
    • ,
  • Mitchell Saltzberg, MD

      Affiliations

    • Good Samaritan Hospital, Heart Failure Program at Midwest Heart Specialists, Downers Grove, IL
    • ,
  • Stefanie R. Ellison, MD, FACEP

      Affiliations

    • University of Missouri–Kansas City School of Medicine, Truman Medical Center, Elmwood Hospital, and Edwards Hospitals, Kansas City, MO
    • ,
  • Meenakshi Awasthi Bhalla, MD

      Affiliations

    • University of California–San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA
    • ,
  • Vikas Bhalla, MD

      Affiliations

    • University of California–San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA
    • ,
  • Paul Clopton, MS

      Affiliations

    • University of California–San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA
    • ,
  • Robert Jesse, MD

      Affiliations

    • Medical College of Virginia, Richmond Veterans Affairs Medical Center, Richmond, VA
    • ,
  • Alan S. Maisel, MD

      Affiliations

    • University of California–San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA
    • Corresponding Author InformationReprint 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.

References 

  1. Weintraub W. Cost and cost-effectiveness studies in heart failure research. Am Heart J. 2002;143:565–576
  2. McCullough P, Philbin E, Spertus J, et al. Confirmation of a heart failure epidemic: findings from the resource utilization among congestive heart failure (REACH) study. J Am Coll Cardiol. 2002;39:60–69
  3. Krumholz HM, Wang Y, Parent EM, et al. Quality of care for elderly patients hospitalized with heart failure. Arch Intern Med. 1997;157:2242–2247
  4. American Journal of Cardiology/Advisory Council to Improve Outcomes Nationwide in Heart Failure . Consensus recommendations for the management of chronic heart failure. Am J Cardiol. 1999;83:1A–38A
  5. Dao Q, Krishnaswamy P, Kazanegra R, et al. Utility of B-type natriuretic peptide (BNP) in the diagnosis of CHF in an urgent care setting. J Am Coll Cardiol. 2001;37:379–385
  6. Davis M, Espiner E, Richards G, et al. Plasma brain natriuretic peptide in assessment of acute dyspnea. Lancet. 1994;343:440–444
  7. Maisel A, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347:161–167
  8. McCullough PA, Nowak RM, McCord J, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation. 2002;106:416–422
  9. McCullough PA, Hollander JE, Nowak RM, et al. BNP Multinational Study Investigators. Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department. Acad Emerg Med. 2003;10:198–204
  10. Morrison LK, Harrison A, Krishnaswamy P, et al. Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. J Am Coll Cardiol. 2002;39:202–209
  11. Harrison A, Morrison LK, Krishnaswamy P, et al. B-type natriuretic peptide predicts future cardiac events in patients presenting to the emergency department with dyspnea. Ann Emerg Med. 2002;39:131–138
  12. Cheng V, Kazanagra R, Garcia A, et al. A rapid bedside test for B-type natriuretic peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study. J Am Coll Cardiol. 2001;37:386–391
  13. Bettencourt P, Ferreira S, Azevedo A, et al. Preliminary data on the potential usefulness of B-type natriuretic peptide levels in predicting outcome after hospital discharge in patients with heart failure. Am J Med. 2002;113:215–219
  14. Maeda K, Tsutamoto T, Wada A, et al. High level of plasma BNP at discharge is an independent risk factor for mortality and morbidity in patients with congestive heart failure. [abstract] J Am Coll Cardiol. 1999;33:192A
  15. Logeart D, Saudubray C, Beyne P, et al. Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea. J Am Coll Cardiol. 2002;40:1794–1800
  16. Logeart D, Thabut G, Jourdain P, et al. Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure. J Am Coll Cardiol. 2004;43:635–641
  17. Maisel A, Hollander A, Guss D, et al. Primary Results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT). A multicenter study of B-type natriuretic peptide levels, emergency department decision-making, and outcomes in patients presenting with shortness of breath. J Am Coll Cardiol. 2004;44:1328–1333
  18. Maisel A. B-type natriuretic peptide levels: diagnostic and prognostic in congestive heart failure, what's next?. Circulation. 2002;105:2328–2331
  19. Maisel A, McCord J, Nowak R, et al. Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction: results from the Breathing Not Properly Multinational Study. J Am Coll Cardiol. 2003;41:2010–2017
  20. Biosite . TriageBNP package insert. San Diego (Calif): Biosite Inc; 2002;
  21. Wieczorek SJ, Wu AH, Christenson R, et al. A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure: a multicenter evaluation. Am Heart J. 2002;144:834–839
  22. Kazanegra R, Cheng V, Garcia A, et al. A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study. J Card Fail. 2001;7:21–29
  23. McCullough P, Duc P, Omland T, et al. B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study. Am J Kidney Dis. 2003;41:571–579
  24. Graff L, Orledge J, Radford MJ, et al. Correlation of the Agency for Health Care Policy and Research congestive heart failure admission guidance with mortality: peer review organization voluntary association initiative to decrease events (PROVIDE) for congestive heart failure. Ann Emerg Med. 1999;34:429–437
  25. McCord J, Mundy BJ, Hudson MP, et al. Relationship between obesity and B-type natriuretic peptide levels. Arch Intern Med. 2004;164:2247–2252
  26. Mehra MR, Uber PA, Park MH, et al. Obesity and suppressed B-type natriuretic peptide levels in heart failure. J Am Coll Cardiol. 2004;43:1590–1595
  27. Wang TJ, Larson MG, Levy D, et al. Impact of obesity on plasma natriuretic peptide levels. Circulation. 2004;109:594–600

 At the time of the study, Drs Maisel, McCullough, Hollander, Nowak, and Jesse served as consultants and received research support.

 Biosite Inc, San Diego, CA, provided all the Triage BNP devices and meters along with financial support.

PII: S0002-8703(05)00980-4

doi: 10.1016/j.ahj.2005.10.017

American Heart Journal
Volume 151, Issue 5 , Pages 1006-1011 , May 2006

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