The use of B-type natriuretic peptide in the management of elderly patients with acute dyspnoea.
OBJECTIVE
The aim of this study was to define the impact of B-type natriuretic peptide (BNP) levels on the management of elderly patients presenting with acute dyspnoea.


METHODS
We performed a prospective randomized controlled study in 269 elderly patients at least 70 years of age included in the B-type natriuretic peptide for Acute Shortness of breath Evaluation (BASEL) study. Patients were randomly assigned to a diagnostic strategy with (n = 136, BNP group) or without (n = 133, control group) the use of BNP levels provided by a rapid bedside assay. The time to discharge and the total cost of treatment were the primary end-points.


RESULTS
Amongst elderly patients, baseline characteristics were well matched between both groups. The use of BNP levels significantly reduced the time to discharge (median 9.0 in the BNP group versus 11.0 days in the control group; P = 0.029). Total treatment cost was $5381 (95% CI, 4482-6280) in the BNP group when compared with $7411 (95% CI, 6180-8642; P = 0.009) in the control group. In addition, a significant reduction in 30-day mortality was observed (9% in the BNP group versus 17% in the control group; P = 0.039).


CONCLUSIONS
Used in conjunction with other clinical information, rapid measurement of BNP in the emergency department improved the management of elderly patients presenting with acute dyspnoea and thereby reduced the time to discharge and the total treatment cost. In addition, BNP testing seemed to reduce 30-day mortality.
Mueller
C
C
Department of Internal Medicine, Medical Division A, University Hospital, University of Basel, Basel, Switzerland.
Laule-Kilian
K
K
Frana
B
B
Rodriguez
D
D
Rudez
J
J
Scholer
A
A
Buser
P
P
Pfisterer
M
M
Perruchoud
A P
AP
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000097:blood / Q000150:complications / Q000175:diagnosis; D004417:Dyspnea / Q000097:blood* / Q000209:etiology / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011014:Pneumonia / Q000097:blood / Q000150:complications / Q000175:diagnosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications / Q000175:diagnosis
D020097:Natriuretic Peptide, Brain