B-type natriuretic peptide testing reduces time to discharge in patients presenting with acute dyspnea (the BASEL study)

Background

In patients with pulmonary disease it is often challenging to distinguish exacerbated pulmonary disease from congestive heart failure (CHF). B-type natriuretic peptide (BNP) levels are significantly higher in CHF as compared with exacerbated pulmonary disease.

Methods

This study evaluated the predefined subgroup of 226 patients with a history of pulmonary disease included in a prospective randomized controlled trial of BNP testing for the emergency diagnosis of acute dyspnea. Patients were randomly assigned to a diagnostic strategy with (n = 119, BNP group) or without (n = 107, clinical group) the use of BNP levels provided by a rapid bedside assay. The time to discharge and the total cost of treatment were recorded as the primary endpoints.

Results

Baseline demographic and clinical characteristics were well matched between groups. Comorbidity was extensive, including coronary artery disease and hypertension in one-half of the patients. The primary discharge diagnosis was CHF and exacerbated obstructive pulmonary disease in 39% and 33%, respectively. The use of BNP levels significantly reduced the need for hospital admission (81% vs 91%, P = 0.034). The median time to discharge was 9.0 days in the BNP group as compared with 12.0 days (P = 0.001) in the clinical group. The total cost of treatment was $5764 (95% confidence interval, 4450–7078) in the BNP group as compared with $7665 (95% confidence interval, 6448–8882; P = 0.038) in the clinical group (Fig. 1). Inhospital mortality was 8% in both groups.

Figure 1

Table

Conclusion

Used in conjunction with other clinical information, rapid measurement of BNP reduced the time to discharge and total treatment cost of patients with a history of pulmonary disease presenting with acute dyspnea.