Diagnostic performance and cost effectiveness of measurements of plasma N-terminal pro brain natriuretic peptide in patients presenting with acute dyspnea or peripheral edema

被引:29
作者
Behnes, Michael [2 ]
Brueckmann, Martina [2 ]
Ahmad-Nejad, Parviz [1 ]
Lang, Siegfried [2 ]
Wolpert, Christian [2 ]
Elmas, Elif [2 ]
Kaelsch, Thorsten [2 ]
Gruettner, Joachim [2 ]
Weiss, Christel [3 ]
Borggrefe, Martin [2 ]
Neumaier, Michael [1 ]
机构
[1] Heidelberg Univ, Fac Med Mannheim, Inst Clin Chem, D-68167 Mannheim, Germany
[2] Heidelberg Univ, Fac Med Mannheim, Dept Med 1, D-68167 Mannheim, Germany
[3] Heidelberg Univ, Fac Med Mannheim, Dept Stat Anal, D-68167 Mannheim, Germany
关键词
Cost; Dyspnea; Edema; Heart failure; NT-proBNP; HEART-FAILURE; SYSTOLIC DYSFUNCTION; EMERGENCY DIAGNOSIS; BNP; GUIDELINES; MANAGEMENT; BIOMARKER; DISEASE; UPDATE;
D O I
10.1016/j.ijcard.2008.03.045
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
Background: The purpose of this study was to determine the diagnostic power of a newly available assay for amino-terminal pro-brain natriuretic peptide (NT-proBNP) to identify patients with acute heart failure. In addition, the influence of initial NT-proBNP measurements on economic consequences, diagnostic procedures and staff involvement was evaluated. Methods and results: 401 patients presenting with acute dyspnea or peripheral edema in the emergency department were enrolled. NT-proBNP was measured after initial clinical evaluation. Clinical routine care and diagnostic assessment were blinded to NT-proBNP results. Two cardiologists independently validated the period of hospitalization, clinical examinations and medical therapies of each patient considering NT-proBNP results. The median NT-proBNP level among patients with acute congestive heart failure (CHF) (n=122) was 3497 pg/ml as compared to 320 pg/ml in patients without (n=279) (p<0.0001). An NT-proBNP cutoff level <300 pg/ml was optimal to rule out acute CHF (negative predictive value 96%; sensitivity 96%). NT-proBNP >= 300 pg/ml could strongly predict acute CHF when compared to patients' history or physical examination (odds ratio 9.5; p<0.0001) and diagnostic technical findings (odds ratio 14.7; p<0.05). In patients with NT-proBNP<300 pg/ml, 14% of the period of hospitalization could be saved, corresponding to savings of US $481 per patient. In addition, 9% of the number and time of staff involvement of clinical examinations and therapies could be saved, 10% of the costs of clinical examinations. Chest X-rays were saved in 34%, echocardiography in 9%. Conclusions: Measurement of NT-proBNP leads to multiple saving amounts and optimizes diagnostic pathways and resource allocation. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:165 / 174
页数:10
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