Clinical Question: In patients with...

Clinical Question: In patients with pulmonary disease, can brain natriuretic peptide (BNP) testing effectively guide therapy?

Setting: pressing necessity department

Study Design: Randomized controll trial (single-blinded)

Allocation: Concealed

Synopsis: This report is a subgroup analysis of the BASEL studious mood (Mueller C, et al. Use of B-type natriuretic peptide in the elevation and management of acute dyspnea. N Engl J M 2004;350:647-54) which showed the effectiveness of BNP testing in the management of patients with heart failure who not away with acute decompensation to an juncture department. In this analysis, 226 patients had a history of pulmonary disease: 72 percent had a history of chronic obstructive pulmonary disease or asthma. Other pulmonary diseases included pneumonia, pulmonary embolism, and interstitial lung disease.

Patients were assigned randomly (allocation concealed) to usual care appendixed by a rapid BNP experiment or the usual diagnostic protocol without knowledge of BNP even Physicians were advised that a BNP flat lower than 100 pg through mL (100 ng per L) made heart failure unlikely, a rise greater than 500 pg through mL (500 ng per L) made heart failure highly likely, and that intermediate values required additional information and clinical sentence to make the diagnosis.

The BNP on a level was not measured during any succeeding hospitalization. Outcomes were assessed according to a group blinded to treatment assignment. Heart failure was the major cause of acute dyspnea in 39 percent of patients, closely followed by way of an exacerbation of obstructive pulmonary disease (33 percent) and pneumonia (16 percent) Patients in the BNP assign places to were less likely to be admitted (81 versus 91 percent; P = 034) and exhausted less time in the hospital (nine versus 12 days; P = 001)

The median require to be paid [i]or[/i] undergone of care was lower in the BNP form into groups ($4,841 versus $5,671; P = 008) In-hospital mortality was similar in one as well as the other groups. These results parallel the springs demonstrated in the complete BASEL study

Bottom Line: In patients with preexisting pulmonary disease, BNP testing in the sudden [i]or[/i] unexpected occurrence department can effectively distinguish an exacerbation caused through heart failure from one caused on pulmonary disease. As a spring hospitalizations are fewer, probably because of the initiation of more appropriate therapy in the pressing necessity department. Also, the duration of the hospital stay is shorter and the take away from is lower. (Level of Evidence: 1b)

ALLEN F SHAUGHNESSY, PHARM.D.

reflection Reference: Mueller C, et al. Use of B-type natriuretic peptide in the management of acute dyspnea in patients with pulmonary disease. Am Heart J February 2006;151:471-7

Used with permission from Shaughnessy AF. BNP testing beneficial with CHF + pulmonary dx Accessed March 30 2006 at: http://www.InfoPOEMs.com.

COPYRIGHT 2006 American Academy of Family Physicians

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