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Biomarker testing may help manage possible heart failure in the ED
Adding N-terminal proB-type natriuretic peptide testing to clinical assessment saved money per patient, reduced duration of ED visits.
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CHICAGO — N-terminal proB-type natriuretic peptide testing along with clinical assessment improved patient outcomes in the emergency department, according to Canadian researchers.
The test saved about $1,000 Canadian dollars per patient in Canada’s publicly funded, universal access health care system.
Gordon W. Moe, MD, director of the HF program and biomarker laboratory, St. Michael’s Hospital, Toronto, presented data from the Improved Management of Patients with Congestive HF (IMPROVE-CHF) trial at the American Heart Association Scientific Sessions 2006.
Because patients are frequently readmitted to the hospital in Canada, leading to high costs, the researchers tested the hypothesis that understanding N-terminal proB-type natriuretic peptide (NT-proBNP) values will improve management of patients with suspected acute HF and dyspnea. The prospective, multicenter, randomized, controlled evaluation compared usual treatment with NT-proBNP care.
The researchers randomized 501 patients to receive usual care (n=251) or NT-proBNP (n=244). More than 30% had a history of HF or left ventricular dysfunction, according to Moe.
The researchers conducted a 60-day follow-up and economic analysis. NT-proBNP with clinical assessment improved overall management of patients with suspected HF presenting to the ED, Moe said. The median duration of the ED visit in the NT-proBNP group was 5.6 hours, compared with 6.3 hours in the usual care group.
However, the median duration of the ICU stay was not significantly lower in the NT-proBNP group compared with the usual care group (6.1 days vs. 5.5 days.)
Cost outcomes of NT-proBNP testing compared with the usual care were lower during initial ED visits and hospitalization, initial ED visits and initial hospitalization, all ED visits and all hospitalizations and all ED visits, all hospitalizations and all outpatient visits (P=.017).
Cost outcomes did not differ significantly between groups for initial ED visits, including the cost of the NT-proBNP test, initial and subsequent ED visits and initial hospitalization.
The population-diverse study included elderly patients and women, which was one of its strengths, according to discussant Margaret Redfield, MD, professor of medicine, Mayo Clinic, Rochester, Minn.
However, because the study occurred in Canada under a universal, publicly funded system, the question remains whether the findings will translate to other health care systems, she said. – by Lauren Riley
For more information:
- Moe GW. N-terminal proB-type natriuretic peptide improves the management of patients with suspected acute decompensated heart failure: primary results of the Canadian multicenter IMPROVE-CHF study. Presented at: American Heart Association Scientific Sessions 2006; Nov. 12-15, 2006; Chicago.