Timing of Immunoreactive B-Type Natriuretic Peptide Levels and Treatment Delay in Acute Decompensated Heart Failure

Abstract

In the ED setting, delayed measurement of iBNP levels and delay in treatment for ADHF were strongly associated. These delays were linked with modestly increased in-hospital mortality, independent of other prognostic variables. The adverse impact of delay was most notable in patients with greater iBNP levels (Registry for Acute Decompensated Heart Failure Patients; NCT00366639).

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012

“…516,517 In parallel, coexisting life-threatening clinical conditions and/or precipitants that require urgent treatment/correction need to be immediately identified and managed (Figure 12.2). Typically, an initial step in the diagnostic workup of AHF is to rule out alternative causes for the patient's symptoms and signs (i.e.…”

Contemporary In-Hospital Management Strategies for Acute Decompensated Heart Failure

“…A retrospective analysis of the ADHERE database suggests that there is a significant reduction in mortality, hospital length of stay, admissions to the intensive care unit, invasive procedures, and prolonged hospitalizations when intravenous vasodilators (nesiritide, nitroglycerin, nitroprusside) and/or positive inotropes (milrinone, dobutamine) are initiated in the emergency department within 6 hours of an ADHF presentation. 20,21 However, whether prompt emergency department intervention impacts intermediate-to long-term outcomes remains unknown. 22 Individual therapeutic choices for ADHF are reviewed later in the text in detail.…”

Using Natriuretic Peptides for Selection of Patients in Acute Heart Failure Clinical Trials

“…However, there is no easily identifiable optimum cut point value for each peptide (the overall sensitivity for both biomarkers in AHF may be as high as 96%, but the specificity is only 69%) 19 . The timing of the lab measurement is also critical, as data suggests that a delay in obtaining BNP was independently associated with increased in-hospital mortality and was associated with a delayed diagnosis of AHF 20 . In RELAX-AHF, patients enrolled presented with AHF within the previous 16 hours with dyspnea at rest or with minimum exertion 14 .…”