• Amaali Lokuge, Louisa Lam, Peter Cameron, Henry Krum, Smit de Villiers, Adam Bystrzycki, Matthew T Naughton, David Eccleston, Genevieve Flannery, Jacob Federman, and Hans-Gerhard Schneider.
• Emergency and Trauma Centre, Melbourne, Victoria, Australia.
• Circ Heart Fail. 2010 Jan 1;3(1):104-10.

BackgroundIt is often difficult to diagnose heart failure (HF) accurately in patients presenting with dyspnea to the emergency department (ED). This study assessed whether B-type natriuretic peptide (BNP) testing in these patients improved the accuracy of HF diagnosis.Methods And ResultsPatients presenting to the Alfred and the Northern Hospital EDs with a chief complaint of dyspnea were enrolled prospectively from August 2005 to April 2007. Patients were randomly allocated to have BNP levels tested or not. The diagnostic gold standard for HF was determined by 1 cardiologist and 1 emergency or respiratory physician who, blinded to the BNP result, independently reviewed all available information. The ED diagnosis of HF in the non-BNP group showed a sensitivity, specificity, and accuracy of 65%, 92%, and 81%, respectively. The BNP group had a similar sensitivity, specificity, and accuracy of 66%, 90%, and 78%, respectively, for the diagnosis of HF in the ED. There was no significant difference between the BNP and non-BNP groups in any of the measures of diagnostic accuracy for HF.ConclusionsIn the clinical setting of EDs, availability of BNP levels did not significantly improve the accuracy of a diagnosis of HF. Clinical Trial Registration- clinicaltrials.gov. Identifier: NCT00163709.

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