N-terminal pro–brain natriuretic peptide testing in the emergency department: Beneficial effects on hospitalization, costs, and outcome

Rutten, Joost H.W.; Steyerberg, Ewout W.; Boomsma, Frans; van Saase, Jan L.C.M.; Deckers, Jaap W.; Hoogsteden, Henk C.; Lindemans, Jan; van den Meiracker, Anton H.

doi:10.1016/j.ahj.2008.02.021

« Previous Next »American Heart Journal
Volume 156, Issue 1 , Pages 71-77, July 2008

N-terminal pro–brain natriuretic peptide testing in the emergency department: Beneficial effects on hospitalization, costs, and outcome

Joost H.W. Rutten, MD
- Department of Internal Medicine, Erasmus Medical College-University Medical Center Rotterdam, Rotterdam, The Netherlands
Ewout W. Steyerberg, PhD
- Department of Public Health, Erasmus Medical College-University Medical Center Rotterdam, Rotterdam, The Netherlands
Frans Boomsma, PhD
- Department of Internal Medicine, Erasmus Medical College-University Medical Center Rotterdam, Rotterdam, The Netherlands
Jan L.C.M. van Saase, MD, PhD
- Department of Internal Medicine, Erasmus Medical College-University Medical Center Rotterdam, Rotterdam, The Netherlands
Jaap W. Deckers, MD, PhD
- Department of Cardiology, Thoraxcenter, Erasmus Medical College-University Medical Center Rotterdam, Rotterdam, The Netherlands
Henk C. Hoogsteden, MD, PhD
- Department of Pulmonary Medicine, Erasmus Medical College-University Medical Center Rotterdam, Rotterdam, The Netherlands
Jan Lindemans, PhD
- Department of Clinical Chemistry, Erasmus Medical College-University Medical Center Rotterdam, Rotterdam, The Netherlands
Anton H. van den Meiracker, MD, PhD
- Department of Internal Medicine, Erasmus Medical College-University Medical Center Rotterdam, Rotterdam, The Netherlands
- Reprint requests: Anton H. van den Meiracker, MD, PhD, Erasmus MC, Department of Internal Medicine, Room D 432, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.

Received 7 October 2007; accepted 12 February 2008. published online 28 May 2008.

Background

N-terminal pro–brain natriuretic peptide (NT-proBNP) is an established biomarker for heart failure. Assessment of this biomarker in patients with acute dyspnea presenting to the emergency department (ED) may aid diagnostic decision-making, resulting in improved patient care and reduced costs.

Methods

In a prospective clinical trial, patients presenting with acute dyspnea to the ED of the Erasmus Medical College, Rotterdam, the Netherlands, were randomized for either rapid measurement or no measurement of NT-proBNP. For ruling out heart failure, cutoff values of 93 pg/mL in male and 144 pg/mL in female patients were used, and for ruling in heart failure, a cutoff value of 1,017 pg/mL was used. Time to discharge from the hospital and costs related to hospital admission were primary end points. Bootstrap analysis was used for comparison of costs and 30-day mortality between the NT-proBNP and control group.

Results

A total of 477 patients (54% male) was enrolled. The mean age was 59 years, with 44% of patients having a history of cardiac disease. Median time to discharge from the hospital was 1.9 days (interquartile range [IQR], 0.12-8.4 days) in the NT-proBNP group (n = 241) compared with 3.9 days (IQR, 0.16-11.0 days) in the control group (n = 236) (P = .04). Introduction of NT-proBNP testing resulted in a trend toward reduction in costs related to hospital admission and diagnostic investigations of $1,364 per patient (95% CI $−246 to $3,215), whereas 30-day mortality was similar (15 patients in the NT-proBNP and 18 patients in the control group).

Conclusions

Introduction of NT-proBNP testing for heart failure in the ED setting reduces the time to discharge and is associated with a trend toward cost reduction.