Use of B-Type Natriuretic Peptide in the Evaluation and Management of Acute Dyspnea

doi:10.1056/NEJMoa031681

Volume 350:647-654		February 12, 2004		Number 7

Use of B-Type Natriuretic Peptide in the Evaluation and Management of Acute Dyspnea

Christian Mueller, M.D., André Scholer, Ph.D., Kirsten Laule-Kilian, B.Sc., Benedict Martina, M.D., Christian Schindler, Ph.D., Peter Buser, M.D., Matthias Pfisterer, M.D., and André P. Perruchoud, M.D.

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ABSTRACT

Background B-type natriuretic peptide levels are higher in patientswith congestive heart failure than in patients with dyspneafrom other causes.

Methods We conducted a prospective, randomized, controlled studyof 452 patients who presented to the emergency department withacute dyspnea: 225 patients were randomly assigned to a diagnosticstrategy involving the measurement of B-type natriuretic peptidelevels with the use of a rapid bedside assay, and 227 were assessedin a standard manner. The time to discharge and the total costof treatment were the primary end points.

Results Base-line demographic and clinical characteristics werewell matched between the two groups. The use of B-type natriureticpeptide levels reduced the need for hospitalization and intensivecare; 75 percent of patients in the B-type natriuretic peptidegroup were hospitalized, as compared with 85 percent of patientsin the control group (P=0.008), and 15 percent of those in theB-type natriuretic peptide group required intensive care, ascompared with 24 percent of those in the control group (P=0.01).The median time to discharge was 8.0 days in the B-type natriuretic peptide group and 11.0 days in the control group (P=0.001).The mean total cost of treatment was $5,410 (95 percent confidenceinterval, $4,516 to $6,304) in the B-type natriuretic peptidegroup, as compared with $7,264 (95 percent confidence interval,$6,301 to $8,227) in the control group (P=0.006). The respective 30-day mortality rates were 10 percent and 12 percent (P=0.45).

Conclusions Used in conjunction with other clinical information,rapid measurement of B-type natriuretic peptide in the emergencydepartment improved the evaluation and treatment of patientswith acute dyspnea and thereby reduced the time to dischargeand the total cost of treatment.

Source Information

From the Department of Internal Medicine, Medical Division A (C.M., K.L.-K., A.P.P.), the Department of Laboratory Medicine (A.S.), the Emergency Department (B.M.), the Institute for Social and Preventive Medicine (C.S.), and the Division of Cardiology (P.B., M.P.), University of Basel, University Hospital, Basel, Switzerland.

Address reprint requests to Dr. Mueller at Medizinische Klinik A, Universitätsklinik, Petersgraben 4, CH-4031 Basel, Switzerland, or at chmueller{at}uhbs.ch.

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B-Type Natriuretic Peptide in the Evaluation of Acute Dyspnea
Martinez-Selles M., Mueller C., Perruchoud A. P.
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N Engl J Med 2004; 350:2416-2417, Jun 3, 2004. Correspondence

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