Document Detail


Use of B-type natriuretic peptide in the management of acute dyspnea in patients with pulmonary disease.
MedLine Citation:
PMID:  16442916     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In patients with pulmonary disease, it is often challenging to distinguish exacerbated pulmonary disease from congestive heart failure (CHF). The impact of B-type natriuretic peptide (BNP) measurements on the management of patients with pulmonary disease and acute dyspnea remains to be defined. METHODS: This study evaluated the subgroup of 226 patients with a history of pulmonary disease included in the BASEL Study. Patients were randomly assigned to a diagnostic strategy with (n = 119, BNP group) or without (n = 107, clinical group) the use of BNP levels provided by a rapid bedside assay. Time to discharge and total cost of treatment were recorded as the primary end points. RESULTS: Baseline characteristics were similar in patients assigned to the BNP and control groups. Comorbidity was extensive, including coronary artery disease and hypertension in half of patients. The primary discharge diagnosis was CHF and exacerbated obstructive pulmonary disease in 39% and 33%, respectively. The use of BNP levels significantly reduced the need for hospital admission (81% vs 91%, P = .034). Median time to discharge was 9.0 days in the BNP group as compared with 12.0 days (P = .001) in the clinical group. Median total cost of treatment was $4841 in the BNP group as compared with $5671 in the clinical group (P = .008). Inhospital mortality was 8% in both groups. CONCLUSIONS: CHF is a major cause of acute dyspnea in patients with a history of pulmonary disease. Used in conjunction with other clinical information, rapid measurement of BNP reduced time to discharge and total treatment cost of these patients.
Authors:
Christian Mueller; Kirsten Laule-Kilian; Barbara Frana; Daniel Rodriguez; André Scholer; Christian Schindler; André P Perruchoud
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  151     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-30     Completed Date:  2006-02-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  471-7     Citation Subset:  AIM; IM    
Affiliation:
Medical Division A, Department of Internal Medicine, University Hospital, University of Basel, Basel, Switzerland. chmueller@uhbs.ch
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Asthma / complications
Atrial Natriuretic Factor / blood*
Biological Markers / blood
Confidence Intervals
Coronary Artery Disease / complications
Dyspnea / economics,  etiology*
Emergencies
Female
Heart Failure / complications*,  diagnosis,  economics
Humans
Hypertension / complications
Length of Stay
Male
Pneumonia / complications
Pulmonary Disease, Chronic Obstructive / complications,  diagnosis*,  economics
Pulmonary Embolism / complications
Chemical
Reg. No./Substance:
0/Biological Markers; 85637-73-6/Atrial Natriuretic Factor

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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