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Diagnostic performance and cost effectiveness of measurements of plasma N-terminal pro brain natriuretic peptide in patients presenting with acute dyspnea or peripheral edema.
Int J Cardiol. 2009 Jun 26; 135(2):165-74.IJ

Abstract

BACKGROUND

The purpose of this study was to determine the diagnostic power of a newly available assay for amino-terminal pro-brain natriuretic peptide (NT-proBNP) to identify patients with acute heart failure. In addition, the influence of initial NT-proBNP measurements on economic consequences, diagnostic procedures and staff involvement was evaluated.

METHODS AND RESULTS

401 patients presenting with acute dyspnea or peripheral edema in the emergency department were enrolled. NT-proBNP was measured after initial clinical evaluation. Clinical routine care and diagnostic assessment were blinded to NT-proBNP results. Two cardiologists independently validated the period of hospitalization, clinical examinations and medical therapies of each patient considering NT-proBNP results. The median NT-proBNP level among patients with acute congestive heart failure (CHF) (n=122) was 3497 pg/ml as compared to 320 pg/ml in patients without (n=279) (p<0.0001). An NT-proBNP cutoff level <300 pg/ml was optimal to rule out acute CHF (negative predictive value 96%; sensitivity 96%). NT-proBNP >or=300 pg/ml could strongly predict acute CHF when compared to patients' history or physical examination (odds ratio 9.5; p<0.0001) and diagnostic technical findings (odds ratio 14.7; p<0.05). In patients with NT-proBNP<300 pg/ml, 14% of the period of hospitalization could be saved, corresponding to savings of US $481 per patient. In addition, 9% of the number and time of staff involvement of clinical examinations and therapies could be saved, 10% of the costs of clinical examinations. Chest X-rays were saved in 34%, echocardiography in 9%.

CONCLUSIONS

Measurement of NT-proBNP leads to multiple saving amounts and optimizes diagnostic pathways and resource allocation.

Authors+Show Affiliations

First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18603317

Citation

Behnes, Michael, et al. "Diagnostic Performance and Cost Effectiveness of Measurements of Plasma N-terminal Pro Brain Natriuretic Peptide in Patients Presenting With Acute Dyspnea or Peripheral Edema." International Journal of Cardiology, vol. 135, no. 2, 2009, pp. 165-74.
Behnes M, Brueckmann M, Ahmad-Nejad P, et al. Diagnostic performance and cost effectiveness of measurements of plasma N-terminal pro brain natriuretic peptide in patients presenting with acute dyspnea or peripheral edema. Int J Cardiol. 2009;135(2):165-74.
Behnes, M., Brueckmann, M., Ahmad-Nejad, P., Lang, S., Wolpert, C., Elmas, E., Kaelsch, T., Gruettner, J., Weiss, C., Borggrefe, M., & Neumaier, M. (2009). Diagnostic performance and cost effectiveness of measurements of plasma N-terminal pro brain natriuretic peptide in patients presenting with acute dyspnea or peripheral edema. International Journal of Cardiology, 135(2), 165-74. https://doi.org/10.1016/j.ijcard.2008.03.045
Behnes M, et al. Diagnostic Performance and Cost Effectiveness of Measurements of Plasma N-terminal Pro Brain Natriuretic Peptide in Patients Presenting With Acute Dyspnea or Peripheral Edema. Int J Cardiol. 2009 Jun 26;135(2):165-74. PubMed PMID: 18603317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic performance and cost effectiveness of measurements of plasma N-terminal pro brain natriuretic peptide in patients presenting with acute dyspnea or peripheral edema. AU - Behnes,Michael, AU - Brueckmann,Martina, AU - Ahmad-Nejad,Parviz, AU - Lang,Siegfried, AU - Wolpert,Christian, AU - Elmas,Elif, AU - Kaelsch,Thorsten, AU - Gruettner,Joachim, AU - Weiss,Christel, AU - Borggrefe,Martin, AU - Neumaier,Michael, Y1 - 2008/07/07/ PY - 2008/01/12/received PY - 2008/03/06/accepted PY - 2008/7/8/pubmed PY - 2009/9/2/medline PY - 2008/7/8/entrez SP - 165 EP - 74 JF - International journal of cardiology JO - Int J Cardiol VL - 135 IS - 2 N2 - BACKGROUND: The purpose of this study was to determine the diagnostic power of a newly available assay for amino-terminal pro-brain natriuretic peptide (NT-proBNP) to identify patients with acute heart failure. In addition, the influence of initial NT-proBNP measurements on economic consequences, diagnostic procedures and staff involvement was evaluated. METHODS AND RESULTS: 401 patients presenting with acute dyspnea or peripheral edema in the emergency department were enrolled. NT-proBNP was measured after initial clinical evaluation. Clinical routine care and diagnostic assessment were blinded to NT-proBNP results. Two cardiologists independently validated the period of hospitalization, clinical examinations and medical therapies of each patient considering NT-proBNP results. The median NT-proBNP level among patients with acute congestive heart failure (CHF) (n=122) was 3497 pg/ml as compared to 320 pg/ml in patients without (n=279) (p<0.0001). An NT-proBNP cutoff level <300 pg/ml was optimal to rule out acute CHF (negative predictive value 96%; sensitivity 96%). NT-proBNP >or=300 pg/ml could strongly predict acute CHF when compared to patients' history or physical examination (odds ratio 9.5; p<0.0001) and diagnostic technical findings (odds ratio 14.7; p<0.05). In patients with NT-proBNP<300 pg/ml, 14% of the period of hospitalization could be saved, corresponding to savings of US $481 per patient. In addition, 9% of the number and time of staff involvement of clinical examinations and therapies could be saved, 10% of the costs of clinical examinations. Chest X-rays were saved in 34%, echocardiography in 9%. CONCLUSIONS: Measurement of NT-proBNP leads to multiple saving amounts and optimizes diagnostic pathways and resource allocation. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/18603317/Diagnostic_performance_and_cost_effectiveness_of_measurements_of_plasma_N_terminal_pro_brain_natriuretic_peptide_in_patients_presenting_with_acute_dyspnea_or_peripheral_edema_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(08)00510-X DB - PRIME DP - Unbound Medicine ER -