Diagnostic performance and cost effectiveness of measurements of plasma N-terminal pro brain natriuretic peptide in patients presenting with acute dyspnea or peripheral edema.
BACKGROUND
The purpose of this study was to determine the diagnostic power of a newly available assay for amino-terminal pro-brain natriuretic peptide (NT-proBNP) to identify patients with acute heart failure. In addition, the influence of initial NT-proBNP measurements on economic consequences, diagnostic procedures and staff involvement was evaluated.


RESULTS
401 patients presenting with acute dyspnea or peripheral edema in the emergency department were enrolled. NT-proBNP was measured after initial clinical evaluation. Clinical routine care and diagnostic assessment were blinded to NT-proBNP results. Two cardiologists independently validated the period of hospitalization, clinical examinations and medical therapies of each patient considering NT-proBNP results. The median NT-proBNP level among patients with acute congestive heart failure (CHF) (n=122) was 3497 pg/ml as compared to 320 pg/ml in patients without (n=279) (p<0.0001). An NT-proBNP cutoff level <300 pg/ml was optimal to rule out acute CHF (negative predictive value 96%; sensitivity 96%). NT-proBNP >or=300 pg/ml could strongly predict acute CHF when compared to patients' history or physical examination (odds ratio 9.5; p<0.0001) and diagnostic technical findings (odds ratio 14.7; p<0.05). In patients with NT-proBNP<300 pg/ml, 14% of the period of hospitalization could be saved, corresponding to savings of US $481 per patient. In addition, 9% of the number and time of staff involvement of clinical examinations and therapies could be saved, 10% of the costs of clinical examinations. Chest X-rays were saved in 34%, echocardiography in 9%.


CONCLUSIONS
Measurement of NT-proBNP leads to multiple saving amounts and optimizes diagnostic pathways and resource allocation.
Behnes
Michael
M
First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Brueckmann
Martina
M
Ahmad-Nejad
Parviz
P
Lang
Siegfried
S
Wolpert
Christian
C
Elmas
Elif
E
Kaelsch
Thorsten
T
Gruettner
Joachim
J
Weiss
Christel
C
Borggrefe
Martin
M
Neumaier
Michael
M
D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002624:Chemistry, Clinical / Q000191:economics / Q000379:methods*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004417:Dyspnea / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D004487:Edema / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D004632:Emergency Medical Services / Q000191:economics; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D017721:Hospital Costs; D006801:Humans; D016015:Logistic Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain