AHA: Blood Test Improves Management of Acute Heart Failure

November 15, 2006

CHICAGO -- A widely available blood test for heart failure should be used more frequently when patients arrive at the emergency department with shortness of breath, researchers said here.

CHICAGO, Nov. 15 -- A widely available blood test for heart failure should be used more frequently when patients present to the emergency department with shortness of breath, researchers said here.

The N-terminal proB-type natriuretic peptide (NT-proBNP) test significantly improved diagnoses and reduced hospitalizations compared with clinical judgment alone, said Gordon W. Moe, M.D., of St. Michael's Hospital in Toronto, and colleagues, at the American Heart Association meeting.

In a study of 501 patients who presented with dyspnea to seven Canadian emergency departments, the addition of NT-proBNP test results to clinical evaluation reduced the 60-day hospitalization risk by 20% (P=0.0122) and the number of patients hospitalized in the same period (51 versus 33 patients with clinical judgment alone, P=0.044).

The test also significantly increased sensitivity and specificity for heart failure diagnosis (area under the curve 0.904 versus 0.834 for clinical judgment alone and 0.855 for the test alone).

What's more, the test, costing less than , yielded a 15% reduction in costs of about per patient. It is already widely used in the United States, but it remains poorly utilized in other nations including Canada, though commonly available.

"The test should be more widely used in the right patient population of those who present with shortness of breath and where diagnosis is unclear," Dr. Moe said.

"Oftentimes this is a confusing situation," said Timothy Gardner, M.D., of the Christiana Care Health Services in Wilmington, Del., who commented on the study.

In the study, physicians committed to a diagnosis of acute decompensated heart failure (later adjudicated by cardiologists blinded to the NT-proBNP test results) without test results. Then, patients (average age 75, 52% male) were randomized to usual care (254) or management guided by NT-proBNP results. Blood samples were obtained in the emergency department for all patients.

Average NT-proBNP levels were significantly higher in the 227 patients (47%) whose final diagnosis was acute decompensated heart failure than in those with other diagnoses (3097 pg/ml versus 461 pg/ml, P