B-type natriuretic peptide testing and the accuracy of heart failure diagnosis in the emergency department.
BACKGROUND
It is often difficult to diagnose heart failure (HF) accurately in patients presenting with dyspnea to the emergency department (ED). This study assessed whether B-type natriuretic peptide (BNP) testing in these patients improved the accuracy of HF diagnosis.


RESULTS
Patients presenting to the Alfred and the Northern Hospital EDs with a chief complaint of dyspnea were enrolled prospectively from August 2005 to April 2007. Patients were randomly allocated to have BNP levels tested or not. The diagnostic gold standard for HF was determined by 1 cardiologist and 1 emergency or respiratory physician who, blinded to the BNP result, independently reviewed all available information. The ED diagnosis of HF in the non-BNP group showed a sensitivity, specificity, and accuracy of 65%, 92%, and 81%, respectively. The BNP group had a similar sensitivity, specificity, and accuracy of 66%, 90%, and 78%, respectively, for the diagnosis of HF in the ED. There was no significant difference between the BNP and non-BNP groups in any of the measures of diagnostic accuracy for HF.


CONCLUSIONS
In the clinical setting of EDs, availability of BNP levels did not significantly improve the accuracy of a diagnosis of HF. Clinical Trial Registration- clinicaltrials.gov. Identifier: NCT00163709.
Lokuge
Amaali
A
Emergency and Trauma Centre, Melbourne, Victoria, Australia.
Lam
Louisa
L
Cameron
Peter
P
Krum
Henry
H
de Villiers
Smit
S
Bystrzycki
Adam
A
Naughton
Matthew T
MT
Eccleston
David
D
Flannery
Genevieve
G
Federman
Jacob
J
Schneider
Hans-Gerhard
HG
D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012680:Sensitivity and Specificity
D020097:Natriuretic Peptide, Brain