title: The impact of amino-terminal pro-brain natriuretic peptide testing on hospital length of stay and morbidity in patients with acute decompensated heart failure.
abstract: BACKGROUND
  In clinical trials, N-terminal pro-brain natriuretic peptide (NT-proBNP) testing has been shown to be valuable for diagnosis and triage of patients with acute decompensated heart failure. It is not yet clear what benefits might be expected from the initiation of NT-proBNP testing in an everyday clinical setting.
  
  
  OBJECTIVE
  To determine the effects of NT-proBNP testing on hospital length of stay as well as on 60-day morbidity and mortality in patients with acute decompensated heart failure before and after the test was implemented in the clinical laboratory.
  
  
  METHODS
  We measured hospital length of stay and 60-day morbidity and mortality rates among patients with acute decompensated heart failure admitted before and after initiation of NT-proBNP testing in our hospital. Differences in demographics between preimplementation and postimplementation groups were compared with the chi2 test for categorical variables and the Wilcoxon rank sum test for continuous variables. Comparison between the hospital length of stay for each group was evaluated using the Mann-Whitney U test. Differences in rates of rehospitalization or death at 60 days following presentation were assessed using chi2 cross-tabulation.
  
  
  RESULTS
  Patients in the postimplementation group had similar clinical features as those in the preimplementation group. The hospital length of stay for patients in the postimplementation study group decreased both with respect to mean (1.86-day reduction) and median (1.3-day reduction) hospital stay (both, P = .03). Additionally, significantly lower rates of death (6.6% absolute risk reduction, P = .01), rehospitalization (12.1% absolute risk reduction, P = .005), and the composite of the 2 rates (18.7% absolute risk reduction, P = .008) were found following initiation of NT-proBNP testing.
  
  
  CONCLUSIONS
  Implementation of NT-proBNP testing may result in significant reductions in hospital length of stay as well as improvements in rates of morbidity and mortality in patients with acute decompensated heart failure.
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Fruit Street, Boston, MA 02114, USA.
authors.forename: Sandy M
authors.initials: SM
authors.lastname: Green
authors.forename: Patrick
authors.initials: P
authors.lastname: Redmond
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Samir
authors.initials: S
authors.lastname: Aleryani
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lee-Lewandrowski
authors.forename: Patrick
authors.initials: P
authors.lastname: Sluss
authors.forename: Kent B
authors.initials: KB
authors.lastname: Lewandrowski
mesh_terms: D015415:Biomarkers / Q000097:blood; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007902:Length of Stay; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain