OBJECTIVES: The rapid and accurate diagnosis of heart failure in primary care is a major unmet clinical need. We evaluated the additional use of B-type natriuretic peptide (BNP) levels. DESIGN: A randomized controlled trial. SETTING:Twenty-nine primary care physicians in Switzerland and Germany coordinated by the University Hospital Basel, Switzerland. SUBJECTS: A total of 323 consecutive patients presenting with dyspnoea. INTERVENTIONS: Assignment in a 1 : 1 ratio to a diagnostic strategy including point-of-care measurement of BNP (n = 163) or standard assessment without BNP (n = 160). The total medical cost at 3 months was the primary end-point. Secondary end-points were diagnostic certainty, time to appropriate therapy, functional capacity, hospitalization and mortality. The final diagnosis was adjudicated by a physician blinded to the BNP levels. RESULTS:Heart failure was the final diagnosis in 34% of patients. The number of hospitalizations, functional status and total medical cost at 3 months [median $1655, interquartile range (IQR), 850-3331 vs. $1541, IQR 859-2827; P = 0.68] were similar in both groups. BNP increased diagnostic certainty as defined by the need for further diagnostic work-up (33% vs. 45%; P = 0.02) and accelerated the initiation of the appropriate treatment (13 days vs. 25 days; P = 0.01). The area under the receiver-operating characteristics curve for BNP to identify heart failure was 0.87 (95% confidence interval, 0.81-0.93). CONCLUSIONS: The use of BNP levels in primary care did not reduce total medical cost, but improved some of the secondary end-points including diagnostic certainty and time to initiation of appropriate treatment.
RCT Entities:
OBJECTIVES: The rapid and accurate diagnosis of heart failure in primary care is a major unmet clinical need. We evaluated the additional use of B-type natriuretic peptide (BNP) levels. DESIGN: A randomized controlled trial. SETTING: Twenty-nine primary care physicians in Switzerland and Germany coordinated by the University Hospital Basel, Switzerland. SUBJECTS: A total of 323 consecutive patients presenting with dyspnoea. INTERVENTIONS: Assignment in a 1 : 1 ratio to a diagnostic strategy including point-of-care measurement of BNP (n = 163) or standard assessment without BNP (n = 160). The total medical cost at 3 months was the primary end-point. Secondary end-points were diagnostic certainty, time to appropriate therapy, functional capacity, hospitalization and mortality. The final diagnosis was adjudicated by a physician blinded to the BNP levels. RESULTS:Heart failure was the final diagnosis in 34% of patients. The number of hospitalizations, functional status and total medical cost at 3 months [median $1655, interquartile range (IQR), 850-3331 vs. $1541, IQR 859-2827; P = 0.68] were similar in both groups. BNP increased diagnostic certainty as defined by the need for further diagnostic work-up (33% vs. 45%; P = 0.02) and accelerated the initiation of the appropriate treatment (13 days vs. 25 days; P = 0.01). The area under the receiver-operating characteristics curve for BNP to identify heart failure was 0.87 (95% confidence interval, 0.81-0.93). CONCLUSIONS: The use of BNP levels in primary care did not reduce total medical cost, but improved some of the secondary end-points including diagnostic certainty and time to initiation of appropriate treatment.
Authors: Caroline Morbach; Thomas Buck; Christian Rost; Sebastian Peter; Stephan Günther; Stefan Störk; Christiane Prettin; Raimund Erbel; Georg Ertl; Christiane E Angermann Journal: Clin Res Cardiol Date: 2017-11-15 Impact factor: 5.460
Authors: Olivia R Ferry; Yao C Huang; Philip J Masel; Michael Hamilton; Kwun M Fong; Rayleen V Bowman; Scott C McKenzie; Ian A Yang Journal: J Thorac Dis Date: 2019-10 Impact factor: 2.895
Authors: Moritz F Sinner; Katherine A Stepas; Carlee B Moser; Bouwe P Krijthe; Thor Aspelund; Nona Sotoodehnia; João D Fontes; A Cecile J W Janssens; Richard A Kronmal; Jared W Magnani; Jacqueline C Witteman; Alanna M Chamberlain; Steven A Lubitz; Renate B Schnabel; Ramachandran S Vasan; Thomas J Wang; Sunil K Agarwal; David D McManus; Oscar H Franco; Xiaoyan Yin; Martin G Larson; Gregory L Burke; Lenore J Launer; Albert Hofman; Daniel Levy; John S Gottdiener; Stefan Kääb; David Couper; Tamara B Harris; Brad C Astor; Christie M Ballantyne; Ron C Hoogeveen; Andrew E Arai; Elsayed Z Soliman; Patrick T Ellinor; Bruno H C Stricker; Vilmundur Gudnason; Susan R Heckbert; Michael J Pencina; Emelia J Benjamin; Alvaro Alonso Journal: Europace Date: 2014-07-18 Impact factor: 5.214