ClinicalTrials.gov Registration Number: NCT00130611.
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Original Article
B-type natriuretic peptide in the evaluation and management of dyspnoea in primary care
Article first published online: 12 JUN 2012
DOI: 10.1111/j.1365-2796.2012.02552.x
© 2012 The Association for the Publication of the Journal of Internal Medicine
Additional Information
How to Cite
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. and Mueller, C. (2012), B-type natriuretic peptide in the evaluation and management of dyspnoea in primary care. Journal of Internal Medicine, 272: 504–513. doi: 10.1111/j.1365-2796.2012.02552.x
These findings were presented in part as a ‘Late Breaking Clinical Trial’ during the Scientific Session at the meeting of the Heart Failure Association of the European Society of Cardiology, June 2010 in Berlin, Germany.
Publication History
- Issue published online: 22 OCT 2012
- Article first published online: 12 JUN 2012
- Accepted manuscript online: 2 MAY 2012 10:26AM EST
Keywords:
- B-type natriuretic peptide;
- cost;
- dyspnoea;
- heart failure;
- primary care
Abstract. 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 (University Hospital Basel, Basel; University Hospital, Basel, Switzerland). B-type natriuretic peptide in the evaluation and management of dyspnoea in primary care. J Intern Med 2012; 272: 504–513.
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 3 months 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 3 months [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 (13 days vs. 25 days; 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.