Adding B-type natriuretic peptide testing to clinical judgment improved the diagnostic accuracy for congestive heart failure in patients with acute dyspnea (AUC 0.93 vs 0.86; P<0.0001).
Observational (n=1,586)
Blinded
Yes
Does adding BNP testing to clinical judgment improve diagnostic accuracy for congestive heart failure in patients presenting with acute dyspnea in the emergency department?
Adding BNP testing to clinical judgment significantly improves the diagnostic accuracy of congestive heart failure in patients presenting to the emergency department with acute dyspnea.
Effect estimate: AUC (95% CI 0.92 to 0.94)
Absolute Event Rate: 0.93% vs 0.86%
p-value: p=<0.0001
Background — We sought to determine the degree to which B-type natriuretic peptide (BNP) adds to clinical judgment in the diagnosis of congestive heart failure (CHF). Methods and Results — The Breathing Not Properly Multinational Study was a prospective diagnostic test evaluation study conducted in 7 centers. Of 1586 participants who presented with acute dyspnea, 1538 (97%) had clinical certainty of CHF determined by the attending physician in the emergency department. Participants underwent routine care and had BNP measured in a blinded fashion. The reference standard for CHF was adjudicated by 2 independent cardiologists, also blinded to BNP results. The final diagnosis was CHF in 722 (47%) participants. At an 80% cutoff level of certainty of CHF, clinical judgment had a sensitivity of 49% and specificity of 96%. At 100 pg/mL, BNP had a sensitivity of 90% and specificity of 73%. In determining the correct diagnosis (CHF versus no CHF), adding BNP to clinical judgment would have enhanced diagnostic accuracy from 74% to 81%. In those participants with an intermediate (21% to 79%) probability of CHF, BNP at a cutoff of 100 pg/mL correctly classified 74% of the cases. The areas under the receiver operating characteristic curve were 0.86 (95% CI 0.84 to 0.88), 0.90 (95% CI 0.88 to 0.91), and 0.93 (95% CI 0.92 to 0.94) for clinical judgment, for BNP at a cutoff of 100 pg/mL, and for the 2 in combination, respectively ( P <0.0001 for all pairwise comparisons). Conclusions — The evaluation of acute dyspnea would be improved with the addition of BNP testing to clinical judgment in the emergency department.
McCullough et al. (Tue,) conducted a observational in Acute dyspnea / Congestive heart failure (n=1,586). B-type natriuretic peptide (BNP) testing combined with clinical judgment vs. Clinical judgment alone was evaluated on Area under the receiver operating characteristic curve for diagnosis of CHF (AUC, 95% CI 0.92 to 0.94, p=<0.0001). Adding B-type natriuretic peptide testing to clinical judgment improved the diagnostic accuracy for congestive heart failure in patients with acute dyspnea (AUC 0.93 vs 0.86; P<0.0001).