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Delays in testing, treatment may impact on ADHF outcome
6 August 2008
MedWire News: Delays in measuring immunoreactive brain natriuretic peptide (iBNP) levels and treating patients hospitalized with acute decompensated heart failure (ADHF) are strongly linked to one another, and may impact on patients' outcomes, reports a US team.
The investigators say: "Prompt measurement of iBNP levels should be considered as part of the immediate initial evaluation in patients with suspected ADHF in the emergency department setting."
Although BNP measurement helps diagnose HF, it was previously unclear whether the time to establishing BNP levels is related to the time to initiating treatment or influences clinical outcomes in patients with ADHF.
Alan Maisel (University of California, San Diego, USA) and colleagues studied 58,465 ADHF episodes among patients enrolled in ADHERE (ADHF National Registry).
They report in the Journal of the American College of Cardiology that there was a strong positive relationship between the time iBNP level was drawn and the time to initial intravenous diuretic treatment.
"Patients with the longest average time to iBNP draw also had the longest time to treatment," explain Maisel et al. The relationship held true across all quartiles of iBNP levels.
Further analysis showed that the proportion of patients who were asymptomatic at the time of discharge decreased as the delay before initiating their treatment increased.
Multivariable analysis showed that time to iBNP draw was a modest independent predictor of in-hospital mortality, with each hour of extra delay associated with mortality at an odds ratio of 1.004 (p=0.0002).
Time to diuretic treatment was also modestly associated with in-hospital mortality, at an odds ratio of 1.021 for each 4-hour delay increment (p=0.0001).
"This effect occurred across a wide spectrum of initial iBNP levels, but was most notable in patients with greater iBNP levels, suggesting that the impact of treatment delay may be amplified in more severely ill patients," the authors write.
