title: B-type natriuretic peptide in the evaluation and management of dyspnoea in primary care.
abstract: OBJECTIVE
  The rapid and accurate diagnosis of heart failure in primary care is a major unmet clinical need. We evaluated the additional use of B-type natriuretic peptide (BNP) levels.
  
  
  METHODS
  A randomized controlled trial.
  
  
  METHODS
  Twenty-nine primary care physicians in Switzerland and Germany coordinated by the University Hospital Basel, Switzerland.
  
  
  METHODS
  A total of 323 consecutive patients presenting with dyspnoea.
  
  
  METHODS
  Assignment in a 1 : 1 ratio to a diagnostic strategy including point-of-care measurement of BNP (n = 163) or standard assessment without BNP (n = 160). The total medical cost at 3 months was the primary end-point. Secondary end-points were diagnostic certainty, time to appropriate therapy, functional capacity, hospitalization and mortality. The final diagnosis was adjudicated by a physician blinded to the BNP levels.
  
  
  RESULTS
  Heart failure was the final diagnosis in 34% of patients. The number of hospitalizations, functional status and total medical cost at 3 months [median $1655, interquartile range (IQR), 850-3331 vs. $1541, IQR 859-2827; P = 0.68] were similar in both groups. BNP increased diagnostic certainty as defined by the need for further diagnostic work-up (33% vs. 45%; P = 0.02) and accelerated the initiation of the appropriate treatment (13 days vs. 25 days; P = 0.01). The area under the receiver-operating characteristics curve for BNP to identify heart failure was 0.87 (95% confidence interval, 0.81-0.93).
  
  
  CONCLUSIONS
  The use of BNP levels in primary care did not reduce total medical cost, but improved some of the secondary end-points including diagnostic certainty and time to initiation of appropriate treatment.
authors.affiliation: Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel Friedbergstrasse 1, 9220 Gossau Chesa Sinfonia, 7515 Sils-Maria, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Burri
authors.forename: K
authors.initials: K
authors.lastname: Hochholzer
authors.forename: N
authors.initials: N
authors.lastname: Arenja
authors.forename: H
authors.initials: H
authors.lastname: Martin-Braschler
authors.forename: L
authors.initials: L
authors.lastname: Kaestner
authors.forename: H
authors.initials: H
authors.lastname: Gekeler
authors.forename: T
authors.initials: T
authors.lastname: Hatziisaak
authors.forename: M
authors.initials: M
authors.lastname: Büttiker
authors.forename: A
authors.initials: A
authors.lastname: Fräulin
authors.forename: M
authors.initials: M
authors.lastname: Potocki
authors.forename: T
authors.initials: T
authors.lastname: Breidthardt
authors.forename: T
authors.initials: T
authors.lastname: Reichlin
authors.forename: T
authors.initials: T
authors.lastname: Socrates
authors.forename: R
authors.initials: R
authors.lastname: Twerenbold
authors.forename: C
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D004417:Dyspnea / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000097:blood*; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000191:economics; D011320:Primary Health Care; D012372:ROC Curve; D013902:Radiography, Thoracic; D016037:Single-Blind Method
chemical_list: D015415:Biomarkers; D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain