title: The use of B-type natriuretic peptide in the management of patients with atrial fibrillation and dyspnea.
abstract: The utility of B-type natriuretic peptide (BNP) testing in patients with atrial fibrillation (AF) is poorly defined. We analyzed patients (n=452) included in the BNP for Acute Shortness of Breath Evaluation (BASEL) study. Patients were randomly assigned to a diagnostic strategy with or without the use of BNP. Ninety-nine patients presented with AF (n=48 BNP group; n=51 control group). Although comparable with respect to gender and cardiopulmonary comorbidity, patients with AF were older and more often had heart failure as the cause of dyspnea. In addition, patients with AF had higher in-hospital mortality (13% versus 6%, P=0.012). The use of BNP significantly reduced time to discharge (BNP group median 8 days [1-16] versus 12 days [IQR 4-21] control group; P=0.046) in patients with AF. Initial total treatment costs (median) were $4239 [769-7422] in the BNP group and $5940 [4024-10848] in the control group (P=0.041). These benefits were maintained after 90 days: patients in the BNP group had spent fewer days in hospital (10 days [2-21] versus 15 days [IQR 9-27]; P=0.022) and induced lower total treatment costs ($4790 [1260-9387] versus $7179 [4311-13173]; P=0.016). In conclusion, the use of BNP seems to improve the management of patients with AF presenting with dyspnea.
authors.affiliation: Department of Internal Medicine, University of Basel, University Hospital, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.forename: Markus
authors.initials: M
authors.lastname: Noveanu
authors.forename: Sevgi
authors.initials: S
authors.lastname: Cayir
authors.forename: Martina
authors.initials: M
authors.lastname: Viglino
authors.forename: Kirsten
authors.initials: K
authors.lastname: Laule
authors.forename: Willibald
authors.initials: W
authors.lastname: Hochholzer
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Mihael
authors.initials: M
authors.lastname: Potocki
authors.forename: Michael
authors.initials: M
authors.lastname: Christ
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D015897:Comorbidity; D003935:Diagnostic Techniques, Cardiovascular; D004417:Dyspnea / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D020097:Natriuretic Peptide, Brain