title: Medical and economic long-term effects of B-type natriuretic peptide testing in patients with acute dyspnea.
abstract: BACKGROUND
  The objective of this prospective study was to assess the medical and economic long-term effects of using B-type natriuretic peptide (BNP) concentrations in the management of patients with acute dyspnea.
  
  
  METHODS
  We performed follow-up analysis of the B-Type Natriuretic Peptide for Acute Shortness of Breath Evaluation, a randomized study including 452 patients who presented to the emergency department with acute dyspnea. Participants were randomly assigned to a diagnostic strategy involving the rapid measurement of BNP concentrations (n = 225) or standard assessment (n = 227). Mortality was assessed at 720 days, morbidity and economic data at 360 days.
  
  
  RESULTS
  BNP testing induced several important changes in initial patient management, including a reduction in the initial hospital admission rate, the use of intensive care, and initial time to discharge. At 720 days, 172 deaths had occurred. Cumulative all-cause 720-day mortality was not different between the BNP group (37%) and the control group (36%, P = 0.6). Morbidity as reflected by days spent in-hospital at 360 days was significantly lower in the BNP group [median 12 days ([interquartile range 2-28 days)] compared with the control group [median 16 (7-32)] days, P = 0.025]. Functional status was similar in both groups. Economic outcome as quantified by total treatment cost at 360 days was significantly improved in the BNP group (mean 10,144 dollars vs 12,748 dollars in the control group, P = 0.008).
  
  
  CONCLUSIONS
  Rapid BNP testing in patients with acute dyspnea has no effect on long-term mortality. However, morbidity as quantified by days spent in-hospital and economic outcome are still improved at 360 days.
authors.affiliation: Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.forename: Kirsten
authors.initials: K
authors.lastname: Laule
authors.forename: Anne-Henny
authors.initials: AH
authors.lastname: Strohmeyer
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.forename: Sophie
authors.initials: S
authors.lastname: Meier
authors.forename: Michael
authors.initials: M
authors.lastname: Fischer
authors.forename: André
authors.initials: A
authors.lastname: Scholer
authors.forename: Markus
authors.initials: M
authors.lastname: Noveanu
authors.forename: Michael
authors.initials: M
authors.lastname: Christ
authors.forename: André P
authors.initials: AP
authors.lastname: Perruchoud
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D004417:Dyspnea / Q000175:diagnosis* / Q000191:economics* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies
chemical_list: D020097:Natriuretic Peptide, Brain