Key result
Knowledge of NT-proBNP levels did not affect overall hospitalization, but patients with high open NT-proBNP (>1800 pg/mL) were more likely to be admitted than blinded patients (P<0.05).
Why the study?
Does knowledge of NT-proBNP levels affect hospitalization rates and resource utilization in patients >65 years old presenting to the medical emergency department?
RCT (n=1,086)
Open-label vs Blinded
Randomized
Yes
Does knowledge of NT-proBNP levels affect hospitalization rates and resource utilization in patients >65 years old presenting to the medical emergency department?
Routine knowledge of NT-proBNP in ED patients >65 years old does not affect overall hospitalization rates but aids in risk stratification and correlates with resource utilization and prognosis.
Knowledge of NT-proBNP does not reduce overall ED hospitalizations; extends evidence for its selective use in risk stratification of high-level patients.
AIMS: N-terminal pro brain natriuretic peptide (NT-proBNP) is a potent marker of heart failure and other cardiac diseases. The value of NT-proBNP testing in the medical emergency department (ED) was assessed in patients >65 years old. METHODS AND RESULTS: This large, prospective, randomized, controlled, multicentre trial was conducted in six medical EDs. Data for evaluation of the primary endpoint of hospitalization were available for 1086 patients. Median NT-proBNP was 582 pg/mL. A total of 16% of patients presented with NT-proBNP <150 pg/mL (low), 55% with NT-proBNP between 150 and 1800 pg/mL (intermediate), and 29% with NT-proBNP >1800 pg/mL (high). NT-proBNP was positively correlated with hospital admission [ odds ratio (OR) for high vs. low 2.9, P < 0.0001], length of stay (8.5 days vs. 3.5 days for high vs. low, P < 0.01), in-hospital death (3.9% vs. 0% for high vs. low, P < 0.01), 6 months re-hospitalization (OR for high vs. low 5.1, P < 0.0001), and 6 months death or re-hospitalization (OR for high vs. low 5.7, P < 0.0001). Knowledge of NT-proBNP had no significant effect on the primary endpoint hospital admission and the secondary endpoints intermediate/intensive care unit (IMC/ICU) admission, length of stay, re-hospitalization and death, or re-hospitalization in the total cohort. However, patients with high open NT-proBNP (>1800 pg/mL) were more likely to be admitted to the hospital (P < 0.05) and IMC/ICU (P < 0.05), whereas patients with low open NT-proBNP (<150 pg/mL) were less likely to be admitted (P < 0.05) compared with patients with blinded NT-proBNP. CONCLUSION: Although NT-proBNP does not affect overall hospitalization, it is associated with better stratification of patient care and is strongly correlated with subsequent utilization of hospital resources and prognosis.
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Luchner et al. (2012) conducted an RCT in Medical emergency department patients (n=1,086). Open NT-proBNP testing vs. Blinded NT-proBNP testing was evaluated on Hospitalization. Knowledge of NT-proBNP levels did not affect overall hospitalization, but patients with high open NT-proBNP (>1800 pg/mL) were more likely to be admitted than blinded patients (P<0.05).
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