Conflict of interest disclosures: W. Frank Peacock—scientific advisory board at Abbott, Beckman-Coulter, Biosite, Inverness, and Response Biomedical; research grants from Abbott, BRAHMS, Biosite, and Inverness. Richard M. Nowak—research grants from BRAHMS. Robert Christenson—scientific advisory board at Siemens, Biosite, Inverness, Ortho Clinical Diagnostics, and Response Biomedical; research grants from Biosite, Inverness, Siemens, Roche, and BRAHMS. Salvatore DiSomma—consultant for Biosite; research grants from BRAHMS. Sean Xavier Neath—no conflicts of interest. Oliver Hartmann—statistical consultant and employee of BRAHMS GmbH (manufacturer of the MR-proANP, copeptin, and MR-proADM assays). Christian Mueller—scientific advisory board at Abbott and BRAHMS; research grants from Abbott, BRAHMS, Biosite, and Nanosphere. Piotr Ponikowski—no conflict of interest. Martin Mockel—research grants from BRAHMS. Christopher Hogan—no conflicts of interest. Alan H.B. Wu—research grants from BRAHMS and Response Biomedical; scientific advisory board at Beckman, Abbott, and Inverness. Mark Richards—honoraria and consultancy for Inverness, BRAHMs, and Roche Diagnostics. Gerasimos S. Filippatos—research grant from BRAHMS. Inder Anand—research grant from BRAHMS. Leong L. Ng—research grants from BRAHMS. Lori B. Daniels—research grants from Biosite and Roche. Nils Morgenthaler—employee of BRAHMS GmbH (manufacturer of the MR-proANP, Copeptin and MR-proADM assays). Stefan D. Anker—research grants from BRAHMS; honoraria from Abbott and Biosite; consultant for BRAHMS, Inverness, and Abbott. Alan S. Maisel—research grants from Roche, Biosite, and Bayer; consultant for Biosite.
Short-term Mortality Risk in Emergency Department Acute Heart Failure
Article first published online: 11 SEP 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 18, Issue 9, pages 947–958, September 2011
How to Cite
Frank Peacock, W., Nowak, R., Christenson, R., DiSomma, S., Neath, S. X., Hartmann, O., Mueller, C., Ponikowski, P., Möckel, M., Hogan, C., Wu, A. H. B., Richards, M., Filippatos, G. S., Anand, I., Ng, L. L., Daniels, L. B., Morgenthaler, N., Anker, S. D. and Maisel, A. S. (2011), Short-term Mortality Risk in Emergency Department Acute Heart Failure. Academic Emergency Medicine, 18: 947–958. doi: 10.1111/j.1553-2712.2011.01150.x
Bach Trial Registration. ClinicalTrials.gov Identifier: NCT00537628.
Supervising Editor: Stephen Smith, MD.
- Issue published online: 11 SEP 2011
- Article first published online: 11 SEP 2011
- Received December 15, 2010; revisions received February 6 and February 24, 2011; accepted March 4, 2011.
ACADEMIC EMERGENCY MEDICINE 2011; 18:947–958 © 2011 by the Society for Academic Emergency Medicine
Objectives: Few tools exist that provide objective accurate prediction of short-term mortality risk in patients presenting with acute heart failure (AHF). The purpose was to describe the accuracy of several biomarkers for predicting short-term death rates in patients diagnosed with AHF in the emergency department (ED).
Methods: The Biomarkers in ACute Heart failure (BACH) trial was a prospective, 15-center, international study of patients presenting to the ED with nontraumatic dyspnea. Clinicians were blinded to all investigational markers, except troponin and natriuretic peptides, which used the local hospital reference range. For this secondary analysis, a core lab was used for all markers except troponin. This study evaluated patients diagnosed with AHF by the on-site emergency physician (EP).
Results: In the 1,641 BACH patients, 466 (28.4%) had an ED diagnosis of AHF, of whom 411 (88.2%) had a final diagnosis of AHF. In the ED-diagnosed HF patients, 59% were male, 69% had a HF history, and 19 (4.1%) died within 14 days of their ED visit. The area under the curve (AUC) for the 14-day mortality receiver operating characteristic (ROC) curve was 0.484 for brain natriuretic peptide (BNP), 0.586 for N-terminal pro-B-type natriuretic peptide (NT-proBNP), 0.755 for troponin (I or T), 0.742 for adrenomedullin (MR-proADM), and 0.803 for copeptin. In combination, MR-proADM and copeptin had the best 14-day mortality prediction (AUC = 0.818), versus all other markers.
Conclusions: MR-proADM and copeptin, alone or in combination, may provide superior short-term mortality prediction compared to natriuretic peptides and troponin. Presented results are explorative due to the limited number of events, but validation in larger trials seems promising.