B-type natriuretic peptide in the evaluation and management of dyspnoea in primary care

Authors


  • ClinicalTrials.gov Registration Number: NCT00130611.

  • 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.

Christian Mueller, Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
(fax: +41-61-2655353; e-mail: chmueller@uhbs.ch).

Abstract

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 (= 163) or standard assessment without BNP (= 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; = 0.68] were similar in both groups. BNP increased diagnostic certainty as defined by the need for further diagnostic work-up (33% vs. 45%; = 0.02) and accelerated the initiation of the appropriate treatment (13 days vs. 25 days; = 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.

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