Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea

Background: B-type natriuretic peptide levels are higher in patients with congestive heart failure than in patients with dyspnea from other causes. Methods: We conducted a prospective, randomized, controlled study of 452 patients who presented to the emergency department with acute dyspnea: 225 patients were randomly assigned to a diagnostic strategy involving the measurement of B-type natriuretic peptide levels with the use of a rapid bedside assay, and 227 were assessed in a standard manner. The time to discharge and the total cost of treatment were the primary end points. Results: Base-line demographic and clinical characteristics were well matched between the two groups. The use of B-type natriuretic peptide levels reduced the need for hospitalization and intensive care; 75 percent of patients in the B-type natriuretic peptide group were hospitalized, as compared with 85 percent of patients in the control group (P=0.008), and 15 percent of those in the B-type natriuretic peptide group required intensive care, as compared with 24 percent of those in the control group (P=0.01). The median time to discharge was 8.0 days in the B-type natriuretic peptide group and 11.0 days in the control group (P=0.001). The mean total cost of treatment was $5,410 (95 percent confidence interval, $4,516 to $6,304) in the B-type natriuretic peptide group, as compared with $7,264 (95 percent confidence interval, $6,301 to $8,227) in the control group (P=0.006). The respective 30-day mortality rates were 10 percent and 12 percent (P=0.45). Conclusions: Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide in the emergency department improved the evaluation and treatment of patients with acute dyspnea and thereby reduced the time to discharge and the total cost of treatment.