title: Factors Associated With Natriuretic Peptide Testing in Patients Presenting to Emergency Departments With Suspected Heart Failure.
abstract: Testing for natriuretic peptides (NPs) such as brain natriuretic peptide (BNP) or N-terminal prohormone brain natriuretic peptide (NT-proBNP) in the emergency department (ED) assists in the evaluation of patients with acute heart failure (HF). The aim of this study was to investigate factors related to the use of NP testing in the ED in a large population-based sample in Canada.
  
  
  
  This was a retrospective cohort study using linked administrative data from Alberta in 2012. Patients were included if they had testing for an NP in the ED; a comparator group with HF but without NP testing was also included.
  
  
  
  Of the 16,223 patients in the cohort, 5793 were patients with HF (n = 3148 tested and n = 2645 not tested for NPs) and 10,430 were patients without HF but who were tested for NPs. Patients without HF who were tested for NPs had respiratory disease (34%), non-HF cardiovascular diseases (13%), and other conditions (52%). Patients with HF who were tested had a higher rate of hospital admission from the ED (78.4% vs 62.2%; P < 0.001) and lower 7-day and 90-day repeated ED visit rates compared with those who were not tested. Among patients with HF, male sex, being an urban resident, being seen by an emergency medicine or cardiology specialist, and being seen in hospitals with medium ED visit volumes were associated with increased likelihood of testing for NPs.
  
  
  
  Several factors, including the type of provider and ED clinical volume, influenced the use of NP testing in routine ED practice. Standardization of an NP testing strategy in clinical practice would be useful for health care systems.
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Nariman
authors.initials: N
authors.lastname: Sepehrvand
authors.affiliation: Patient Health Outcomes Research and Clinical Effectiveness Unit, Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bakal
authors.affiliation: Patient Health Outcomes Research and Clinical Effectiveness Unit, Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Meng
authors.initials: M
authors.lastname: Lin
authors.affiliation: Patient Health Outcomes Research and Clinical Effectiveness Unit, Alberta Health Services, Edmonton, Alberta, Canada; Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Finlay
authors.initials: F
authors.lastname: McAlister
authors.affiliation: Laboratory Services, Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: James C
authors.initials: JC
authors.lastname: Wesenberg
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: jae2@ualberta.ca.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
mesh_terms: D000368:Aged; D000416:Alberta; D000072096:Cardiologists; D002318:Cardiovascular Diseases / Q000175:diagnosis; D015331:Cohort Studies; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission / Q000706:statistics & numerical data; D010446:Peptide Fragments / Q000097:blood*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012140:Respiratory Tract Diseases / Q000175:diagnosis; D012189:Retrospective Studies; D012737:Sex Factors; D014505:Urban Population
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain