Because heart failure is the greate...

Because heart failure is the greatest in quantity common reason for hospitalization of bodily substances older than 65 years, efficient management of these patients is important. equal with a careful history, physical examination, and chest radiograph, it many times is difficult to decide whether heart failure is not away in a patient with acute dyspnea. B-type natriuretic peptide (BNP) has demonstrated sensitivity and specificity in the diagnosis of heart failure. This peptide is released according to ventricular myocytes when heart failure causes increased wall elongate Mueller and colleagues investigated the use of BNP in the evaluation of patients with dyspnea.

The consideration was performed at an academic hospital center with 665 consecutive patients presenting to the conjuncture department with acute dyspnea. Exclusion criteria included any traumatic cause for dyspnea, renal failure, and cardiogenic agitation A total of 452 patients was chronicleed in the trial and randomized to standard clinical evaluation or this same evaluation with the inclusion of a rapid assay for BNP

The authors used a BNP on a level of 100 pg per mL as a cutoff indicating where heart failure was accounted unlikely, and an elevation higher than 500 pg for mL as an indication that heart failure was the greatest in quantity likely cause of dyspnea. With intermediate values, physicians relied in succession other standard evaluation measures to decide whether heart failure was present

The cogitation was designed to determine the bulk to which the additional clinical information provided at the BNP assay influenced hospital extent of stay or total price of treatment. The mean age of research participants was 71 years, and about 40 percent were women Patients typically had multiple chronic medical conditions. The principally common comorbidities were coronary artery disease, hypertension, chronic obstructive pulmonary disease, and diabetes.

Use of the BNP assay decreased the average time wearied in the emergency department before initiation of appropriate therapy from 90 to 63 minutes. More rapid determination of the cause of dyspnea and institution of treatment with use of the BNP assay translated into a decreased ne for hospitalization (this rate dropp from 85 to 75 percent) and admission to an intensive care unit (this rate decreased from 24 to 15 percent) Hospital detail of stay was reduced from 11 days with standard evaluation to eight days when BNP comes were available, and total sumptuousness of care decreased from $7264 to $5410

The authors determine that inclusion of a rapid assay for BNP in the pass department evaluation of patients with acute dyspnea decreased the time to initiation of appropriate therapy, succeeding hospitalization rates, length of stay, and overall expense of treatment.

EDITOR'S NOTE: This application of mind adds to the accumulating dead body of evidence suggesting that BNP assays are going to have a part in the evaluation of acute dyspnea similar to the part of cardiac troponins and other enzyme markers in the work-up of patients with chest pain. While these assays cannot replace clinical discernment they do provide useful, objective information that may be helpful when standard evaluation measures do not clearly indicate the diagnosis.--B.Z.

BILL ZEPF MD

Mueller C et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J M February 12 2004;350:647-54

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