N-Terminal Pro–B-Type Natriuretic Peptide Testing Improves the Management of Patients With Suspected Acute Heart Failure Primary Results of the Canadian Prospective Randomized Multicenter IMPROVE-CHF Study

• Published in: Circulation (New York, N.Y.) Vol. 115; no. 24; pp. 3103 - 3110
• Main Authors: Moe, Gordon W., Howlett, Jonathan, Januzzi, James L., Zowall, Hanna
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 19.06.2007
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Ambulatory Care - economics; Atrial Natriuretic Factor - blood; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Canada; Cardiology. Vascular system; Cardiovascular system; Cost Savings; Diseases of the cardiovascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Dyspnea - blood; Dyspnea - diagnosis; Dyspnea - drug therapy; Emergency Medical Services - economics; Female; Health Expenditures; Heart Failure - blood; Heart Failure - diagnosis; Heart Failure - economics; Heart Failure - therapy; Humans; Male; Medical sciences; Middle Aged; National Health Programs - economics; Outcome Assessment (Health Care) - economics; Patient Readmission - economics; Pharmacology. Drug treatments; Prospective Studies; Protein Precursors - blood; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Vasodilator agents. Cerebral vasodilators; Canada; Human; Heart failure; natriuretic peptides; Clinical management; costs and cost analysis; Heart disease; Multicenter study; Cardiovascular disease; healthcare economics and organizations; Cost analysis
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.106.666255

Background— The diagnostic utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure has been documented. However, most of the data were derived from countries with high healthcare resource use, and randomized evidence for utility of NT-proBNP was lacking. Methods and Results— We tested the hypothesis that NT-proBNP testing improves the management of patients presenting with dyspnea to emergency departments in Canada by prospectively comparing the clinical and economic impact of a randomized management strategy either guided by NT-proBNP results or without knowledge of NT-proBNP concentrations. Five hundred patients presenting with dyspnea to 7 emergency departments were studied. The median NT-proBNP level among the 230 subjects with a final diagnosis of heart failure was 3697 compared with 212 pg/mL in those without heart failure ( P <0.00001). Knowledge of NT-proBNP results reduced the duration of ED visit by 21% (6.3 to 5.6 hours; P =0.031), the number of patients rehospitalized over 60 days by 35% (51 to 33; P =0.046), and direct medical costs of all ED visits, hospitalizations, and subsequent outpatient services (US $6129 to US $5180 per patient; P =0.023) over 60 days from enrollment. Adding NT-proBNP to clinical judgment enhanced the accuracy of a diagnosis; the area under the receiver-operating characteristic curve increased from 0.83 to 0.90 ( P <0.00001). Conclusions— In a universal health coverage system mandating judicious use of healthcare resources, inclusion of NT-proBNP testing improves the management of patients presenting to emergency departments with dyspnea through improved diagnosis, cost savings, and improvement in selected outcomes.