Novel blood test helps doctors to manage patients with shortness of breath

ESC Congress 2003: Hot Line I – Medical Treatment & Heart Failure

We have shown that a simple blood test measuring B-type natriuretic peptide (BNP), a marker of heart failure, greatly helps doctors to manage patients presenting with shortness of breath to the emergency department. Used in conjunction with other clinical information, rapid measurement of BNP reduced hospitalisations, reduced need for intensive care, reduced total treatment time and significantly reduced total treatment cost by 25%.

Shortness of breath is the key symptom of numerous disorders. Cardiac and pulmonary disease are very common and the most important. Unfortunately, the rapid and accurate differentiation of cardiac disease (heart failure) from other causes of shortness of breath remains a clinical challenge, especially in the emergency department.

Heart failure is a major public health problem. Currently, there are more than 15 million patients with heart failure in North America and Europe, with nearly 1.5 million new cases every year. Heart failure is the most frequent cause of hospitalisation in patients more than 65 years of age and these hospitalisations contribute significantly to the enormous cost of the disease. The total direct cost of care for heart failure exceed $38 billion in the United States per year. Therefore, cost-effective management is of paramount importance.

BNP levels have been found to be significantly higher in patients with heart failure as compared with patients whose shortness of breath is due to other causes. Finding a low BNP level in a patient with shortness of breath renders heart failure unlikely and helps the doctor to focus on alternative causes. In contrast, a high BNP level strongly argues for heart failure being the cause. Accordingly, heart failure medication can be initiated immediately. Our study is the first in the world to demonstrate that in fact doctors can do a better job with the rapid measurement of this novel cardiac marker.

The BASEL (B-Type Natriuretic Peptide for Acute Shortness of Breath Evaluation) study was carried out in the emergency department of our inner city University hospital in Basel, Switzerland. It was supported by research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the Novartis Foundation, the Krokus Foundation, and the University of Basel. We looked at 452 patients who presented with shortness of breath. The usual diagnostic work-up included patient history, physical examination, ECG, chest X-ray and routine blood tests in all patients. In addition, BNP levels were determined in 225 patients (BNP group). The patients did not know whether their work-up included BNP testing or not. Our results show that the use of BNP levels significantly reduced the need for hospital admission (75% versus 85%) or intensive care (15% versus 24%). Total treatment time was 10.5 days in the BNP group as compared with 13.7 days in the clinical group, a significant reduction of 23%. Total cost of treatment was $5,410 in the BNP group as compared with $7,264 in the clinical group, a significant reduction of 26%. Extrapolating this finding to the cost of hospitalisations for heart failure in the United States in 2000 of $30 billion, the use of this simple blood test may save up to $7 billion each year in the United States alone.

Additional studies have been launched to test whether BNP proves also helpful for the evaluation of patients with shortness of breath presenting in doctors office.

Christian Müller, M.D.
University Hospital, Basel
Switzerland

IMPORTANT: This press release accompanies both a presentation and an ESC press conference given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology