CHICAGO —Measuring N-terminal-proB-type natriuretic peptide in the emergency department facilitated diagnosis of acute heart failure, shortened visits, and saved money, according to results of IMPROVE-CHF, a multicenter randomized-controlled trial of the use of NT-proBNP-guided strategy in the management of suspected acute heart failure.
“Our economic analysis found that adding this test to physician judgment reduced the duration of the emergency department visit from an average of 6.3 hours to an average of 5.6 hours,” Dr. Gordon W. Moe reported at the annual scientific sessions of the American Heart Association.
“In addition, it reduced the number of patients rehospitalized within 60 days from 51 to 33 and reduced costs in 2005 U.S. dollars from $5,592 to $4,631 per patient overall, a savings of $961 per patient,” Dr. Moe said.
The IMPROVE-CHF study included 501 patients who presented to seven Canadian emergency departments with dyspnea. NT-proBNP samples were taken in all patients, but in only about half were the treating physicians made aware of the results. In the other half of patients, physicians utilized standard clinical tools to determine a diagnosis.
Patients were followed for 60 days to determine whether knowledge of NT-proBNP values improved the management of patients with suspected acute heart failure in a publicly funded, universal-access health care setting.
Although the amount of time spent in the ED was significantly reduced, the number of ICU admissions, median duration of ICU stay, and the number of patients requiring hospitalization after their ED visit did not differ between the NT-proBNP group and the usual-care group. By 60 days, 23% of patients enrolled had died or were rehospitalized, with no difference between groups.
Discussant Dr. Margaret M. Redford of the Mayo Clinic in Rochester, Minn., noted that the researchers were not clear on whether the cost savings were caused by more efficient treatment of patients or to less use of other diagnostic testing. It was also unclear whether the test was most helpful in making a diagnosis of heart failure or in excluding heart failure.
She also noted that the setting for IMPROVE-CHF—in Canada, where there is a single-payer system and carefully controlled costs—is both a strength and a limitation of the trial. “In this system costs are already carefully controlled, making it a rigorous testing ground for cost-saving measure … but we cannot assume the savings observed in the Canadian system would necessarily be observed in other health care systems.”