Primary Role of B-Type Natriuretic Peptide Across the Clinical Spectrum: From Emergency Medicine to Transitional Care and Beyond Into the Community

Abstract

Heart failure (HF), the most common reason for hospitalization in Medicare recipients, carries significant mortality and morbidity and is costly to the health care system. HF hospitalizations increase with the increasing age of the population and constitutes Medicare & Medicaid Services' largest expenditure. According to the Acute Decompensated Heart Failure National Registry (ADHERE), a database of more than 100,000 patients who were admitted with a diagnosis of HF, approximately 80% of these patients came from the emergency department (ED) and 89% had dyspnea at the time of ED presentation. Contrary to ADHERE data, the Biomarkers in Acute Heart Failure (BACH) trial indicates 34.6% of 1588 patients presenting to EDs with acute shortness of breath were diagnosed with HF. Although shortness of breath is thought to be predictive of HF, this idea is based on conclusions drawn from a registry enrolling patients with an established diagnosis. The ADHERE study reflects the population with confirmed diagnosis and not the at-risk population with symptoms suggestive of HF, thus emphasizing the need to distinguish and risk-stratify the population presenting to EDs prior to implementing early intervention. This is particularly desirable in patients with diagnosed acute HF for accurate diagnosis and better treatment outcomes.