Assigning patients with heart failure to observation status: B-type natriuretic peptide, ejection fraction, or physician judgment.
It is of clinical and financial importance to identify those heart failure patients who are likely to improve rapidly. The authors evaluated, as predictors of short-term resolution, three clinical variables often used to predict long-term outcome. Consenting patients admitted to the emergency department with dyspnea were examined daily until resolution (symptom reversion to baseline absent worsening clinical signs or x-ray). The authors then compared hours to resolution of heart failure with serum B-type natriuretic peptide (BNP), ejection fraction (EF), and admitting physician prediction. They calculated negative and positive predictive values for EF, BNP, and physician opinion using quintile and published severity standards as cutoffs (for EF and BNP). Among 85 patients, BNP <400 pg/mL and <1000 pg/mL had poor positive predictive values (34% and 22%, respectively), as did EF (21%) and physician opinion (16%-21%, depending on physician confidence). Combining tests did not improve prediction. These results do not support the use of BNP, EF, or clinical assessment in triaging heart failure patients to short-stay status.
Department of Preventive Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Ostidimma
O
Ugwu
George
G
Chrysochoou
Manjule
M
Ashok
Jennifer
J
Waxler
Daniel
D
Shine
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D019370:Observation; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome
D020097:Natriuretic Peptide, Brain