[Effects of real-time analysis of brain natriuretic peptide (BNP) on physicians' decision making in outpatient...

Brain natriuretic peptide (BNP) is a strong diagnostic indicator of heart failure. Currently, automated plasma BNP measurement is possible, allowing physicians to ascertain each outpatient's BNP level on the day of consultation. We investigated whether providing a real-time analysis of BNP would lead to a superior outcome in the outpatient setting. The subjects were 111 outpatients who consulted the cardiovascular internal medicine with a BNP value of 200 pg/ml or more. Of these patients, 53 were assessed before the introduction of the real-time analysis of BNP (Pre group), and 58 were assessed after its introduction (Post group). We compared the courses taken based on physicians' direction between the Pre and Post groups. Three patients were admitted to the hospital on the consultation day, and 55 patients were followed up on an outpatient basis, including 27 patients requiring an adjustment of medication, in the Post group. However, 11 patients were hospitalized and 42 were followed up as outpatients, including 16 patients requiring an adjustment of medication, in the Pre group. The number of patients hospitalized on the consultation day in the Post group was less than half of that in the Pre group. Furthermore, fewer outpatients visited the emergency department before their next scheduled appointment due to heart failure aggravation in the Post than in the Pre group (2 out of 55 vs. 10 out of 42 outpatients; difference, 0.202; 95% CI, 0.069 to 0.334; p=0.003). The provision of BNP analysis at the time of consultation reduced the rate of hospitalization and cardiovascular events in heart-failure outpatients.