B-type natriuretic peptide in the evaluation and management of dyspnoea in primary care
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B-type natriuretic peptide in the evaluation and management of dyspnoea in primary care. / Burri, E.; Hochholzer, K.; Arenja, N.; Martin-Braschler, H.; Kaestner, L.; Gekeler, H.; Hatziisaak, T.; Büttiker, M.; Fräulin, A.; Potocki, M.; Breidthardt, T.; Reichlin, T.; Socrates, T.; Twerenbold, R.; Mueller, C.
In: J INTERN MED, Vol. 272, No. 5, 11.2012, p. 504-513.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - B-type natriuretic peptide in the evaluation and management of dyspnoea in primary care
AU - Burri, E.
AU - Hochholzer, K.
AU - Arenja, N.
AU - Martin-Braschler, H.
AU - Kaestner, L.
AU - Gekeler, H.
AU - Hatziisaak, T.
AU - Büttiker, M.
AU - Fräulin, A.
AU - Potocki, M.
AU - Breidthardt, T.
AU - Reichlin, T.
AU - Socrates, T.
AU - Twerenbold, R.
AU - Mueller, C.
PY - 2012/11
Y1 - 2012/11
N2 - Objectives. The rapid and accurate diagnosis of heart failure in primary care is a major unmet clinical need. We evaluated the additional use of B-type natriuretic peptide (BNP) levels. Design. A randomized controlled trial. Setting. Twenty-nine primary care physicians in Switzerland and Germany coordinated by the University Hospital Basel, Switzerland. Subjects. A total of 323 consecutive patients presenting with dyspnoea. Interventions. Assignment in a 1:1 ratio to a diagnostic strategy including point-of-care measurement of BNP (n=163) or standard assessment without BNP (n=160). The total medical cost at 3months was the primary end-point. Secondary end-points were diagnostic certainty, time to appropriate therapy, functional capacity, hospitalization and mortality. The final diagnosis was adjudicated by a physician blinded to the BNP levels. Results. Heart failure was the final diagnosis in 34% of patients. The number of hospitalizations, functional status and total medical cost at 3months [median $1655, interquartile range (IQR), 850-3331 vs. $1541, IQR 859-2827; P=0.68] were similar in both groups. BNP increased diagnostic certainty as defined by the need for further diagnostic work-up (33% vs. 45%; P=0.02) and accelerated the initiation of the appropriate treatment (13days vs. 25days; P=0.01). The area under the receiver-operating characteristics curve for BNP to identify heart failure was 0.87 (95% confidence interval, 0.81-0.93). Conclusions. The use of BNP levels in primary care did not reduce total medical cost, but improved some of the secondary end-points including diagnostic certainty and time to initiation of appropriate treatment.
AB - Objectives. The rapid and accurate diagnosis of heart failure in primary care is a major unmet clinical need. We evaluated the additional use of B-type natriuretic peptide (BNP) levels. Design. A randomized controlled trial. Setting. Twenty-nine primary care physicians in Switzerland and Germany coordinated by the University Hospital Basel, Switzerland. Subjects. A total of 323 consecutive patients presenting with dyspnoea. Interventions. Assignment in a 1:1 ratio to a diagnostic strategy including point-of-care measurement of BNP (n=163) or standard assessment without BNP (n=160). The total medical cost at 3months was the primary end-point. Secondary end-points were diagnostic certainty, time to appropriate therapy, functional capacity, hospitalization and mortality. The final diagnosis was adjudicated by a physician blinded to the BNP levels. Results. Heart failure was the final diagnosis in 34% of patients. The number of hospitalizations, functional status and total medical cost at 3months [median $1655, interquartile range (IQR), 850-3331 vs. $1541, IQR 859-2827; P=0.68] were similar in both groups. BNP increased diagnostic certainty as defined by the need for further diagnostic work-up (33% vs. 45%; P=0.02) and accelerated the initiation of the appropriate treatment (13days vs. 25days; P=0.01). The area under the receiver-operating characteristics curve for BNP to identify heart failure was 0.87 (95% confidence interval, 0.81-0.93). Conclusions. The use of BNP levels in primary care did not reduce total medical cost, but improved some of the secondary end-points including diagnostic certainty and time to initiation of appropriate treatment.
KW - B-type natriuretic peptide
KW - Cost
KW - Dyspnoea
KW - Heart failure
KW - Primary care
UR - http://www.scopus.com/inward/record.url?scp=84867919066&partnerID=8YFLogxK
U2 - 10.1111/j.1365-2796.2012.02552.x
DO - 10.1111/j.1365-2796.2012.02552.x
M3 - SCORING: Journal article
C2 - 22550938
AN - SCOPUS:84867919066
VL - 272
SP - 504
EP - 513
JO - J INTERN MED
JF - J INTERN MED
SN - 0954-6820
IS - 5
ER -
