NT-proBNP testing in cases of acute heart failure

Moe GW, Howlett J, Januzzi JL et al for the Canadian Multicenter Improved Management of Patients With Congestive Heart Failure (IMPROVE-CHF) Study Investigators. Circulation 2007;115:3103-10

Patients attending the emergency departments of Canadian hospitals with breathlessness suspected to be of cardiac origin were screened for this study of the cost-effectiveness of N terminal pro B type natriuretic peptide (NT-proBNP).

Of these, 500 were randomised to NT-proBNP, guided management, or usual care. The mean age was 70 years and there were equal numbers of males and females. One-third had previous heart failure and more than 40 per cent were taking ACE inhibitors and diuretics.

There was a reduction in the readmission rate of 13 per cent versus 20 per cent. NT-proBNP testing improved diagnosis, as we would expect, but the result was not significant. The paper suggests there may be an application for use of the test where the diagnosis is not clear-cut. This is suggested because less expensive tests were used in patients in the BNP group.

The conclusion of the study was that NT-proBNP may improve management of cases by improving diagnosis. In acute situations, where less and less experienced doctors are involved in acute care, this test may save patients undergoing more expensive tests and being readmitted when the diagnosis is unclear. Whether it is cost-effective depends partly on the cost of the test and its ease of use.

- Dr Kathryn Griffith is a GPSI in cardiology, in York

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