N-terminal proB-type natriuretic peptide may be a useful marker for assessing response to treatment among patients hospitalized with suspected acute heart failure, according to an article in the June 19 issue of Circulation.

The multi-center, randomized-controlled trial, which evaluated 500 patients in seven hospitals, showed that N-terminal proB-type natriuretic peptide use reduced duration of emergency department visits by 21 percent and the number of patients re-hospitalized over 60 days by 35 percent.

The trial enrolled 500 patients who arrived at the hospitals' emergency departments with shortness of breath. Under study protocol, physicians immediately committed to a diagnosis for each patient based on their clinical judgment. Those diagnoses were later judged by cardiologists blinded to each patient's marker results, which were measured upon admission and again at 72 hours.

Patients were then randomized to receive usual care or care guided by marker test results. Median marker level in the 230 patients with final diagnoses of acute heart failure was 3,097 pg/mL compared with 212 pg/mL in patients without acute decompensated heart failure. In establishing a diagnosis, adding the marker level to clinical judgment enhanced accuracy, with the area under the receiver-operating characteristic curve increasing from 0.83 to 0.90.

Early and accurate diagnosis of heart failure is crucial for better quality of care and cost-effective patient management. Use of forms of natriuretic peptide has been shown to provide incremental value in the rapid diagnosis of heart failure in the emergency room. Due to its greater stability, N-terminal proB-type natriuretic peptide (NT-proBNP) may represent the more useful diagnostic marker.

Gordon W. Moe, MD, cardiologist and director of the heart failure program and biomarker laboratory at St. Michael's Hospital in Toronto, Canada, who chaired the study, stated "An approach using NT-proBNP in conjunction with clinical assessment improves the overall management of patients presenting to the emergency department with suspected acute heart failure through the facilitation of diagnosis, and provides health cost savings that are accompanied by an improvement in selected clinical outcomes. The use of the NT-proBNP test will improve the overall management of patients with suspected acute heart failure, and this biomarker should be part of the routine management of these patients."