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

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


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.

MeSH terms

  • Acute Disease
  • Aged, 80 and over
  • Biomarkers / blood
  • Dyspnea / diagnosis*
  • Emergency Medicine*
  • Emergency Service, Hospital* / economics
  • Emergency Service, Hospital* / statistics & numerical data
  • Heart Failure / diagnosis*
  • Heart Failure / mortality
  • Hospital Costs
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Natriuretic Peptide, Brain / blood*
  • Patient Discharge / statistics & numerical data
  • Prospective Studies


  • Biomarkers
  • Natriuretic Peptide, Brain