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Does BNP Testing Reduce Hospital Utilization?

Incorporating BNP results with other clinical information improved the evaluation of dyspnea patients in the ED.

B-type natriuretic peptide (BNP) levels now are measured routinely in many emergency departments (EDs). Although high levels of BNP are associated with heart failure in dyspneic patients, the effect of BNP levels on clinical outcomes is uncertain.

In this Swiss randomized trial, 452 patients who presented to an ED with acute dyspnea were evaluated and managed either with or without BNP testing. Heart failure was considered unlikely when BNP levels were lower than 100 pg/mL and likely when BNP levels exceeded 500 pg/mL. Compared with the control group, the BNP group had significantly lower rates of hospitalization (85% vs. 75%) and intensive-care-unit admission (24% vs. 15%), shorter hospital stays (median, 11 vs. 8 days), and lower treatment costs (US$7264 vs. $5410). In-hospital mortality, 30-day mortality, and 30-day rehospitalization rates were similar in the 2 groups. BNP patients were more likely than controls to receive final diagnoses of chronic obstructive pulmonary disease exacerbation (23% vs. 11%).

Comment: In this study of acutely dyspneic patients, measuring BNP was associated with substantial reductions in hospitalization rates and costs. The authors don't provide much detail to explain how these benefits were achieved, but one clue is the greater propensity to diagnose COPD when BNP was measured; if some of these patients would have been misdiagnosed without BNP testing, they might have received inappropriate initial treatment. These findings should be validated in other studies that tell us how often BNP testing simply reinforces our clinical judgments and how often it actually overturns incorrect diagnoses.

— Allan S. Brett, MD

Published in Journal Watch General Medicine February 20, 2004

Citation(s):

Mueller C et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med 2004 Feb 12; 350:647-54.

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