Reduced readmission rate for alternating diagnoses of heart failure and pulmonary disease after implementation of B-type natriuretic peptide testing.
BACKGROUND
Patients with heart failure (HF) or pulmonary diseases (PD) present with similar symptoms. Effective disease management requires an accurate diagnosis. B-type natriuretic peptide (BNP) is increased in patients with HF and is normal in PD patients without cardiac involvement.


OBJECTIVE
To determine if the readmission rate for patients with either HF or PD who later present with the alternate diagnosis (PD or HF) is decreased with the implementation of BNP testing at one hospital.


METHODS
We retrospectively determined the impact of BNP testing on reducing diagnostic ambiguities for patients admitted to an emergency department (ED) with these diseases. We compared a HF DRG (Diagnostic Related Group) (#428) and PD DRGs (#480-496) before vs. 1 and 2 y after implementation of BNP testing.


RESULTS
In a 12-month period before BNP, there were 42 total visits (15 cases) where a patient presented with a HF DRG and returned within 6 months with a PD DRG, and 41 visits (14 cases) where there was a PD-->HF readmission. One year after BNP implementation, the corresponding number of visits decreased 52% to 20 visits (15 cases) for HF-->PD, and 73% to 11 visits (8 cases) for PD-->HF readmissions. A similar reduction in readmissions was observed in the second year after BNP testing. The total number of HF and PD cases in 1999 (1029 patients) was similar to 2001 (985), and was higher in 2002 (1350) during these time intervals. The ED length-of-stay (LOS) was slightly higher for the HF-->PD cases with BNP testing, whereas there was no change in LOS for the PD-->HF cases.


CONCLUSIONS
We hypothesize that prior to BNP implementation, there may have been diagnostic ambiguities in the initial diagnosis of HF or PD, which contributed to a repeat visit for the alternate diagnosis (PD or HF). With BNP testing, the apparent number of inappropriate visits decreased. Reducing unnecessary ED admissions helps justify the costs for implementing BNP testing in the hospital.
Wu
Alan H B
AH
Department of Pathology and Laboratory Medicine, Hartford Hospital, 80 Seymour St., Hartford, CT 06102, USA. awu@harthosp.org
Harrison
Alex
A
Maisel
Alan S
AS
D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D004632:Emergency Medical Services; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008171:Lung Diseases / Q000097:blood / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010359:Patient Readmission; D012189:Retrospective Studies
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain