Serial B-type natriuretic peptide testing did not improve hospital length of stay (6.5 vs 6.5 days; difference 0.1, 95% CI -1.7 to 1.5) or 30-day readmission compared to usual care.
RCT (n=447)
randomized
Yes
Does serial B-type natriuretic peptide testing to guide treatment improve hospital length of stay, readmission rate, or mortality in patients with acute heart failure?
Serial BNP testing to guide treatment in acute heart failure does not improve hospital length of stay, mortality, or readmission rates compared to usual care.
Effect estimate: difference 0.1 (95% CI -1.7 to 1.5)
Absolute Event Rate: 6.5% vs 6.5%
BACKGROUND: B-type natriuretic peptide is useful to diagnose heart failure. We determined whether the use of serial B-type natriuretic peptide measurements to guide treatment improves the outcome in patients with acute heart failure. METHODS AND RESULTS: We conducted a randomized controlled trial of patients with acute heart failure in 10 academic and community emergency departments. The experimental group received serial B-type natriuretic peptide testing (at 3, 6, 9, and 12 hours then daily). The control group received usual care. Our outcomes were hospital length of stay, 30-day readmission rate, and all-cause mortality. There were 219 controls and 228 experimental patients. Mean age was 64 years, 49% were women, 58% were blacks, and 34% were whites. Groups were similar in baseline characteristics. Comparing the serial testing with the control group, there was no difference in length of stay (6.5 days 95% CI, 5.2 to 7.9 versus 6.5 days 95% CI, 5.6 to 7.3; difference, 0.1 95% CI, -1.7 to 1.5), in-hospital mortality (2.2% 95% CI, 0.9 to 5.0 versus controls, 3.2% 95% CI, 1.6 to 6.5; difference, 1.0% 95% CI, -2.3 to 4.5), 30-day mortality (3.7% 95% CI, 1.8 to 7.5 versus 5.5% 95% CI, 3.0 to 9.8; difference, 1.8% 95% CI, -2.8 to 6.5), or hospital revisit rate (20.2% 95% CI, 15.0 to 26.6 versus 23.7% 95% CI, 18.0 to 30.6; difference, 3.5% 95% CI, -5.1 to 12.1). CONCLUSIONS: In this study of 447 patients hospitalized for suspected heart failure, we were unable to demonstrate a benefit of serial testing with B-type natriuretic peptide in terms of hospital length of stay, mortality, or readmission rate.
Singer et al. (Wed,) conducted a rct in acute heart failure (n=447). serial B-type natriuretic peptide testing vs. usual care was evaluated on hospital length of stay (days) (difference 0.1, 95% CI -1.7 to 1.5). Serial B-type natriuretic peptide testing did not improve hospital length of stay (6.5 vs 6.5 days; difference 0.1, 95% CI -1.7 to 1.5) or 30-day readmission compared to usual care.