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In the Rapid Emergency Department Heart failure Outpatient Trial (REDHOT), Dr. Alan Maisel, from the VA Medical Center in San Diego, California, and colleagues assessed the 90-day outcomes of 464 patients who presented to an ER with shortness of breath. BNP levels were drawn on arrival and the evaluating physician was blinded to this result and to any subsequent BNP measurements.
The researchers' findings appear in the September 15th issue of the Journal of the American College of Cardiology.
Ninety percent of the patients were hospitalized and 67.8% of patients were perceived to have NYHA class III or IV heart failure, the investigators note.
Even though numerous reports have shown that BNP levels predict heart failure severity and prognosis, no significant difference in BNP levels was noted between patients sent home and those who were admitted. Regression analysis confirmed that the ER doctor's decision to admit or discharge a patient did not influence 90-day outcomes, whereas the BNP level did correlate with such outcomes.
Eleven percent of admitted patients had a BNP level <200 pg/mL, the authors point out. By 90 days, 9% of these patients had experienced a heart failure-related medical visit or had died compared with 29% of patients with higher BNP levels (p = 0.006).
"This study was not designed to assess whether patients with low BNP levels can be safely managed as an outpatient; rather, it simply states that a rapid point-of-care BNP test in the ER can lead not only to accurate diagnosis of CHF but also might assist in the assessment of disease severity and prognosis," the researchers state.
In a related editorial, Dr.Torbjorn Omland, from the University of Oslo in Norway, comments that "the REDHOT study results have potentially important implications for clinical practice in the ER. The findings, however, need to be confirmed by larger trials and should not be generalized to settings other than the ER."
J Am Coll Cardiol 2004;44:1328-1335.
The researchers' findings appear in the September 15th issue of the Journal of the American College of Cardiology.
Ninety percent of the patients were hospitalized and 67.8% of patients were perceived to have NYHA class III or IV heart failure, the investigators note.
Even though numerous reports have shown that BNP levels predict heart failure severity and prognosis, no significant difference in BNP levels was noted between patients sent home and those who were admitted. Regression analysis confirmed that the ER doctor's decision to admit or discharge a patient did not influence 90-day outcomes, whereas the BNP level did correlate with such outcomes.
Eleven percent of admitted patients had a BNP level <200 pg/mL, the authors point out. By 90 days, 9% of these patients had experienced a heart failure-related medical visit or had died compared with 29% of patients with higher BNP levels (p = 0.006).
"This study was not designed to assess whether patients with low BNP levels can be safely managed as an outpatient; rather, it simply states that a rapid point-of-care BNP test in the ER can lead not only to accurate diagnosis of CHF but also might assist in the assessment of disease severity and prognosis," the researchers state.
In a related editorial, Dr.Torbjorn Omland, from the University of Oslo in Norway, comments that "the REDHOT study results have potentially important implications for clinical practice in the ER. The findings, however, need to be confirmed by larger trials and should not be generalized to settings other than the ER."
J Am Coll Cardiol 2004;44:1328-1335.
