Abstract 2014: The Use of B-Type Natriuretic Peptide in the Management of Patients with Atrial Fibrillation and Dyspnea
Background: Recent data suggest a lower diagnostic accuracy of B-type natriuretic peptide (BNP) in patients with atrial fibrillation (AF). It was the aim of this study to define the impact of BNP testing on the management of patients with AF presenting with dyspnea.
Methods: We analyzed the subgroup of 99 patients with AF included in the B-type natriuretic peptide for Acute Shortness of Breath Evaluation (BASEL) study. Patients were randomly assigned to a diagnostic strategy with (n=48, BNP group) or without (n=51, control 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: Although comparable with respect to gender and cardiopulmonary comorbidity, patients with AF were older and more often had heart failure as the cause of dyspnea as compared to patients in sinus rhythm. In addition, patients with AF had higher in-hospital mortality. The use of BNP levels significantly reduced time to discharge (median 8 days (IQR, 1–16) in the BNP group versus 12 days (IQR, 4 –21) in the control group; P=0.046) in patients with AF. Initial total treatment costs (median) were $4239 (IQR, 769 –7422) in the BNP group and $5940 (IQR, 4024 –10848) in the control group (P=0.041). At 90 days follow-up, patients in the BNP group had spent significantly fewer days in-hospital as compared to patients in the control group (10 days (IQR, 2–21) versus 15 days (IQR, 9 –27); P=0.022). Total treatment costs at 90 days were $4790 (IQR, 1260 –9387) in the BNP group and $7179 (IQR, 4311–13173) in the control group (P=0.016).
Conclusion: The use of BNP levels improves the management of patients with AF presenting with dyspnea.