Introduction of an NT-proBNP assay to an acute admission unit — A 2-year audit

Murtagh, Gillian; Canniffe, Carla; Mahgoub, Mohamed; Blake, Liam; McCarroll, Nuala; Crowley, Vivion; Bennett, Kathleen; Silke, Bernard

doi:10.1016/j.ejim.2008.04.021

Cited by 10 publications

(10 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is possible that the misdiagnosed ADHF-likely patients were not as sick as those in the former group, as shown by their lower NT-proBNP level, and were, therefore, less likely to be properly diagnosed. Of note, the present study median NT-proBNP value (5000 pg/ml) is identical to the NT-proBNP threshold found by Murtagh et al 17 to stratify in-hospital mortality and LOS.…”

Section: Discussionsupporting

confidence: 87%

“…A recent meta-analysis analysing five heterogeneous trials found a modest benefit, of about 1-day reduction in LOS in tested patients. 15 However, variability in the LOS was large, ranging from 6 to 11 days, reflecting trial diversity, while LOS reduction was particularly seen in trials with longer hospitalization, such as the study by Murtagh et al 17 In the present study, median LOS across all subgroups was about 4–5 days, which may explain the lack of observed benefit.…”

Section: Discussioncontrasting

confidence: 52%

“…Murtagh et al 17 showed in 574 admitted patients that of the 396 patients with NT-proBNP <5000 pg/ml, 8.1% died during admission compared with 22.5% of the 178 patients with NT-proBNP values >5000 pg/ml (p<0.0001). Similarly, of the 16 patients in the present study who died during hospitalization, most were among the ADHFlikely subgroup irrespective of blinding.…”

Section: In-hospital Mortalitymentioning

confidence: 99%

“…It is feasible that an intermediately elevated NT-proBNP level in unblinded ADHF-possible patients prompted a more extensive work up. Murtagh et al 17 have evaluated the effect of the NT-proBNP assay on hospital LOS and in-hospital mortality in 574 patients admitted to an acute medical admission unit. They found that a significantly elevated NT-proBNP level, in the ADHF-likely range, was associated with prolonged hospitalization with a median LOS of 9 days in patients diagnosed with heart failure.…”

Section: Effect Of Test On Losmentioning

confidence: 99%

See 3 more Smart Citations

Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

Meisel

Januzzi

Medvedovski

et al. 2012

European Heart Journal: Acute Cardiovascular Care

View full text Add to dashboard Cite

Background: Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level is useful to diagnose or exclude acutely decompensated heart failure (ADHF) in dyspnoeic patients presenting to the emergency department (ED). Aim: To evaluate the impact of ED NT-proBNP testing on admission, length of stay (LOS), discharge diagnosis and longterm outcome. Methods: Dyspnoeic patients were randomized in the ED to NT-proBNP testing. Admission and discharge diagnoses, and outcomes were examined. Results: During 17 months, 470 patients were enrolled and followed for 2.0±1.3 years. ADHF likelihood, determined at study conclusion by validated criteria, established ADHF diagnosis as unlikely in 86 (17%), possible in 120 (24%), and likely in 293 (59%) patients. The respective admission rates in these subgroups were 80, 91, and 96%, regardless of blinding, and 61.9% of blinded vs. 74.5% of unblinded ADHF-likely patients were correctly diagnosed at discharge (p=0.029), with similar LOS. 2-year mortality within subgroups was unaffected by test, but was lower in ADHF-likely patients with NTproBNP levels below median (5000 pg/ml) compared with those above median (p=0.002). Incidence of recurrent cardiac events tracked NT-proBNP levels. Conclusion: ED NT-proBNP testing did not affect admission, LOS, 2-year survival, or recurrent cardiac events among study patients but improved diagnosis at discharge, and allowed risk stratification even within the ADHF-likely group. (ClinicalTrials.gov#NCT00271128)

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 52%

Section: In-hospital Mortalitymentioning

confidence: 99%

Section: Effect Of Test On Losmentioning

confidence: 99%

See 2 more Smart Citations

Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

Meisel

Januzzi

Medvedovski

et al. 2012

European Heart Journal: Acute Cardiovascular Care

View full text Add to dashboard Cite

show abstract

“…Patients with BNP level of less than 200 pg/mL at admission have been associated with 2% mortality rate as opposed to 9% mortality rate seen in patients with admission BNP level of more than 200 pg/mL [ 28 ]. NT-proBNP level equal to or higher than 5000 pg/mL at admission has been shown to be associated with in-hospital mortality rate of 22.5% and longer length of stay in remaining surviving patients [ 29 ].…”

Section: Diagnosis Of Hfmentioning

confidence: 99%

Heart Failure: Diagnosis, Management and Utilization

Inamdar

Inamdar²

2016

JCM

317

216

View full text Add to dashboard Cite

Despite the advancement in medicine, management of heart failure (HF), which usually presents as a disease syndrome, has been a challenge to healthcare providers. This is reflected by the relatively higher rate of readmissions along with increased mortality and morbidity associated with HF. In this review article, we first provide a general overview of types of HF pathogenesis and diagnostic features of HF including the crucial role of exercise in determining the severity of heart failure, the efficacy of therapeutic strategies and the morbidity/mortality of HF. We then discuss the quality control measures to prevent the growing readmission rates for HF. We also attempt to elucidate published and ongoing clinical trials for HF in an effort to evaluate the standard and novel therapeutic approaches, including stem cell and gene therapies, to reduce the morbidity and mortality. Finally, we discuss the appropriate utilization/documentation and medical coding based on the severity of the HF alone and with minor and major co-morbidities. We consider that this review provides an extensive overview of the HF in terms of disease pathophysiology, management and documentation for the general readers, as well as for the clinicians/physicians/hospitalists.

show abstract

N‐terminal pro‐B‐type natriuretic peptide testing patterns in patients with heart failure with reduced ejection fraction

et al. 2021

View full text Add to dashboard Cite

Aims The N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is a commonly used biomarker in heart failure for diagnosis and prognostication. We aimed to determine the prevalence of NT‐proBNP testing, distribution of NT‐proBNP concentrations, and factors associated with receiving an NT‐proBNP test in patients with heart failure with reduced ejection fraction (HFrEF), including the subset with a worsening heart failure event (WHFE). Methods and results This was a retrospective cohort study using two US databases: (i) the de‐identified Humana Research Database between January 2015 and December 2018 and (ii) the Veradigm PINNACLE Registry® between July 2013 and September 2017. We included adult patients with a confirmed diagnosis of HFrEF. In each data source, a subgroup of patients with a WHFE was identified, where a WHFE was defined as a heart failure‐related hospitalization or receipt of intravenous diuretics. Bivariate and multivariate analyses were conducted to assess factors associated with receiving NT‐proBNP testing. In Cohort 1 (n = 249 238), 9.2% of patients with HFrEF and 10.8% of patients with a WHFE received NT‐proBNP testing. When restricted to patients with at least one laboratory claim, 11.3% of patients with HFrEF and 13.2% of those with a WHFE received NT‐proBNP testing. In Cohort 2 (n = 91 444), 2.3% of patients with HFrEF were tested. Median (inter‐quartile range) NT‐proBNP concentrations among patients with HFrEF were 1399 (423–4087) pg/mL in Cohort 1 and 394 (142–688) pg/mL in Cohort 2. Median (inter‐quartile range) NT‐proBNP concentrations in the subset of patients with a WHFE in each cohort were 2209 (740–5894) and 464 (174–783) pg/mL, respectively. In Cohort 1, 13.4% of all HFrEF patients receiving NT‐proBNP testing and 18.9% of patients with a WHFE had NT‐proBNP values >8000 pg/mL; in Cohort 2, these percentages were 1.0% and 2.5%, respectively. Conclusions In US clinical practice, NT‐proBNP testing was not frequently performed in patients with HFrEF. NT‐proBNP concentrations varied across data sources and subpopulations within HFrEF.

show abstract

Introduction of an NT-proBNP assay to an acute admission unit — A 2-year audit

Cited by 10 publications

References 26 publications

Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

Heart Failure: Diagnosis, Management and Utilization

N‐terminal pro‐B‐type natriuretic peptide testing patterns in patients with heart failure with reduced ejection fraction

Contact Info

Product

Resources

About