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B-type natriuretic peptide in the evaluation and management of dyspnoea in primary care . OBJECTIVES The rapid and accurate diagnosis of heart failure in primary care is a major unmet clinical need . We evaluated the additional use of B-type natriuretic peptide ( BNP ) levels . DESIGN A randomized controlled trial . SETTING Twenty-nine primary care physicians in Switzerland and Germany coordinated by the University Hospital Basel , Switzerland . SUBJECTS A total of 323 consecutive patients presenting with dyspnoea . INTERVENTIONS Assignment in a 1 : 1 ratio to a diagnostic strategy including point-of-care measurement of BNP ( n = 163 ) or standard assessment without BNP ( n = 160 ) . The total medical cost at 3 months was the primary end-point . Secondary end-points were diagnostic certainty , time to appropriate therapy , functional capacity , hospitalization and mortality . The final diagnosis was adjudicated by a physician blinded to the BNP levels . RESULTS Heart failure was the final diagnosis in 34 % of patients . The number of hospitalizations , functional status and total medical cost at 3 months [ median $ 1655 , interquartile range ( IQR ) , 850-3331 vs. $ 1541 , IQR 859-2827 ; P = 0.68 ] were similar in both groups . BNP increased diagnostic certainty as defined by the need for further diagnostic work-up ( 33 % vs. 45 % ; P = 0.02 ) and accelerated the initiation of the appropriate treatment ( 13 days vs. 25 days ; P = 0.01 ) . The area under the receiver-operating characteristics curve for BNP to identify heart failure was 0.87 ( 95 % confidence interval , 0.81-0.93 ) . CONCLUSIONS The use of BNP levels in primary care did not reduce total medical cost , but improved some of the secondary end-points including diagnostic certainty and time to initiation of appropriate treatment .
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Intervention_Pharmacological
B-type natriuretic peptide
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Intervention_Pharmacological
B-type natriuretic peptide ( BNP )
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Intervention_Pharmacological
diagnostic strategy including point-of-care measurement of BNP
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Intervention_Control
standard assessment without BNP
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Intervention_Pharmacological
BNP levels
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Outcome_Physical
B-type natriuretic peptide ( BNP ) levels .
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Outcome_Other
total medical cost at 3 months
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Outcome_Other
diagnostic certainty , time to appropriate therapy , functional capacity
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Outcome_Other
hospitalization
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Outcome_Mortality
mortality
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Outcome_Adverse-effects
Heart failure
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Outcome_Other
number of hospitalizations
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Outcome_Other
functional status
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Outcome_Other
total medical cost at 3 months
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Outcome_Physical
BNP
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Outcome_Other
diagnostic certainty
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Participant_Condition
dyspnoea
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Participant_Condition
B-type natriuretic peptide ( BNP ) levels
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Participant_Sample-size
Twenty-nine
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Participant_Sample-size
323
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Participant_Condition
dyspnoea