NT-proBNP Testing in Patients Presenting to the Emergency Department With Acute Dyspnea: Evaluation of Effects on Treatment, Hospitalisation Rate and Costs

Elevated amino-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma levels are indicative for heart failure. Assessment of this biomarker in patients with acute dyspnoea presenting to the emergency department may aid diagnostic decision-making; resulting in improved patient care and reduced costs.
We will investigate the cost-effectiveness of introduction of NT-proBNP measurements in patients presenting with acute dyspnoea to the emergency department of the Erasmus MC, Rotterdam, the Netherlands. Subjects will be randomised for either rapid measurement of plasma NT-proBNP or no diagnostic measurement of NT-proBNP. For ruling out heart failure, cut-off values of 11 pmol/l in males and 17 pmol/l in female patients will be used, and for ruling in heart failure a cut-off value of 120 pmol/l. Time to discharge from the hospital and costs related to hospital admission are primary end-points.

Diagnostic uncertainty in patients with complaints of shortness of breath presenting to the Emergency Department of a hospital may delay treatment and proper care. In patients with shortness of breath due to heart failure increased plasma levels of NT-pro-B-type natriuretic peptide (NT-proBNP) can be demonstrated. The use of NT-proBNP as a biomarker for heart failure in patients presenting to the emergency department with dyspnea might improve care and reduce length of hospital stay. In our study we will investigate the effect of introduction of NT-proBNP as biomarker for heart failure on treatment, time to discharge and costs.

Study-group: Measurement of NT-proBNP plasma level at presentation in the Emergency Department.
Control-group: No measurement of NT-proBNP plasma level at presentation in the Emergency Department. Blood was collected for determination of NT-proBNP levels at the end of the study.