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. 2012 Feb;42(2):197-205.
doi: 10.1016/j.jemermed.2011.07.014. Epub 2011 Nov 26.

Brain natriuretic peptide in the evaluation of emergency department dyspnea: is there a role?

Christopher R Carpenter  1 , Samuel M Keim, Andrew Worster, Peter Rosen; BEEM (Best Evidence in Emergency Medicine)
Affiliations

Brain natriuretic peptide in the evaluation of emergency department dyspnea: is there a role?

Christopher R Carpenter et al. J Emerg Med. 2012 Feb.

Abstract

Background: Acute decompensated congestive heart failure (ADCHF) is a common etiology of dyspnea in emergency department (ED) patients. Delayed diagnosis of ADCHF increases morbidity and mortality. Two cardiac biomarkers, N-terminal-pro brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) have demonstrated excellent sensitivity in diagnostic accuracy studies, but the clinical impact on patient-oriented outcomes of these tests remains in question.

Clinical question: Does emergency physician awareness of BNP or NT-proBNP level improve ADCHF patient-important outcomes including ED length of stay, hospital length of stay, cardiovascular mortality, or overall health care costs?

Evidence review: Five trials have randomized clinicians to either knowledge of or no knowledge of ADCHF biomarker levels in ED patients with dyspnea and some suspicion for heart failure. In assessing patient-oriented outcomes such as length-of-stay, return visits, and overall health care costs, the randomized controlled trials fail to provide evidence of unequivocal benefit to patients, clinicians, or society.

Conclusion: Clinician awareness of BNP or NT-proBNP levels in ED dyspnea patients does not necessarily improve outcomes. Future ADCHF biomarker trials must assess patient-oriented outcomes in conjunction with validated risk-stratification instruments.

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Figure 1
Figure 1
Clinical decision thresholds for diagnostic testing and therapy (20).
Figure 2
Figure 2
Evidence-based medicine teaching points.
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