title: N-terminal pro-brain natriuretic peptide testing in the emergency department: beneficial effects on hospitalization, costs, and outcome.
abstract: BACKGROUND
  N-terminal pro-brain natriuretic peptide (NT-proBNP) is an established biomarker for heart failure. Assessment of this biomarker in patients with acute dyspnea presenting to the emergency department (ED) may aid diagnostic decision-making, resulting in improved patient care and reduced costs.
  
  
  METHODS
  In a prospective clinical trial, patients presenting with acute dyspnea to the ED of the Erasmus Medical College, Rotterdam, the Netherlands, were randomized for either rapid measurement or no measurement of NT-proBNP. For ruling out heart failure, cutoff values of 93 pg/mL in male and 144 pg/mL in female patients were used, and for ruling in heart failure, a cutoff value of 1,017 pg/mL was used. Time to discharge from the hospital and costs related to hospital admission were primary end points. Bootstrap analysis was used for comparison of costs and 30-day mortality between the NT-proBNP and control group.
  
  
  RESULTS
  A total of 477 patients (54% male) was enrolled. The mean age was 59 years, with 44% of patients having a history of cardiac disease. Median time to discharge from the hospital was 1.9 days (interquartile range [IQR], 0.12-8.4 days) in the NT-proBNP group (n = 241) compared with 3.9 days (IQR, 0.16-11.0 days) in the control group (n = 236) (P = .04). Introduction of NT-proBNP testing resulted in a trend toward reduction in costs related to hospital admission and diagnostic investigations of $1,364 per patient (95% CI $-246 to $3,215), whereas 30-day mortality was similar (15 patients in the NT-proBNP and 18 patients in the control group).
  
  
  CONCLUSIONS
  Introduction of NT-proBNP testing for heart failure in the ED setting reduces the time to discharge and is associated with a trend toward cost reduction.
authors.affiliation: Department of Internal Medicine, Erasmus Medical College-University Medical Center Rotterdam, Rotterdam, The Netherlands. jrutten@erasmusmc.nl
authors.forename: Joost H W
authors.initials: JH
authors.lastname: Rutten
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Frans
authors.initials: F
authors.lastname: Boomsma
authors.forename: Jan L C M
authors.initials: JL
authors.lastname: van Saase
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Deckers
authors.forename: Henk C
authors.initials: HC
authors.lastname: Hoogsteden
authors.forename: Jan
authors.initials: J
authors.lastname: Lindemans
authors.forename: Anton H
authors.initials: AH
authors.lastname: van den Meiracker
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016001:Confidence Intervals; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000191:economics / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009426:Netherlands; D010351:Patient Discharge / Q000191:economics / Q000639:trends; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain