B-type Natriuretic Peptide for Acute Shortness of Breath EvaLuation (BASEL) Study - Private Practice
B-type Natriuretic Peptide for Acute Shortness of Breath EvaLuation (BASEL) Study - Private Practice
Cost-effective management of heart failure and pulmonary disease is of paramount importance.
 Unfortunately, the rapid and accurate differentiation of heart failure from other causes of
 dyspnea in private practice is challenging. B-type natriuretic peptide (BNP) levels are
 significantly higher in patients with congestive heart failure as compared to patients with
 dyspnea due to other causes. As a simple, non-expensive assay easily applicable in private
 practice is available, rapid measurement of BNP might be very helpful in establishing or
 excluding the diagnosis of heart failure in patients presenting with acute dyspnea in private
 practice.

 The aim is to test the hypothesis that a BNP guided diagnostic strategy would improve the
 evaluation and management of patients presenting with acute dyspnea to physicians in private
 practice and thereby reduce total cost of diagnosis and treatment.

 The primary endpoint is total medical cost within 3 months.
Background: Most patients with dyspnea primarily consult physicians in private practice.
 Heart failure and pulmonary disease are "epidemic" disorders and account for the majority of
 cases of dyspnea. There are approximately 24 million individuals in the United States with
 chronic obstructive pulmonary disease and another 10 million persons suffer from asthma.
 These illnesses generate in excess of 17 million physician office visits a year at a cost of
 over $10.4 billion. In addition, there are nearly 1.5 million new cases of heart failure in
 North America and Europe every year. The total direct cost of care for heart failure exceed
 $38 billion in the United States per year. Therefore, cost-effective management of these
 diseases is of paramount importance. Unfortunately, the rapid and accurate differentiation of
 heart failure from other causes of dyspnea in private practice is challenging. The symptoms
 of heart failure may be nonspecific, and signs are not sensitive enough and considerably
 overlap with those of pulmonary disease. In addition, signs of volume overload take time to
 evolve and may be completely absent in patients with acute heart failure.

 B-type natriuretic peptide (BNP) is a neurohormone secreted from the cardiac ventricles in
 response to ventricular volume expansion and pressure overload. BNP levels are significantly
 higher in patients with congestive heart failure as compared to patients with dyspnea due to
 other causes. Recently, the researchers were able to show that the use of BNP levels
 significantly improves the management of patients with acute dyspnea in the emergency
 department. As a simple, non-expensive assay easily applicable in private practice is
 available, rapid measurement of BNP might also be very helpful in establishing or excluding
 the diagnosis of heart failure in patients presenting with acute dyspnea in private practice.

 Aim: To test the hypothesis that a BNP guided diagnostic strategy would improve the
 evaluation and management of patients presenting with acute dyspnea to physicians in private
 practice and thereby reduce total cost of diagnosis and treatment.

 Primary endpoint: Total medical cost within 3 months. Secondary endpoints: Hospitalisation,
 time interval to the initiation of the most appropriate therapy, 3-month mortality, dyspnea
 (NYHA) at 3 months, 12-month mortality, 12-month total medical cost, cost-effectiveness.

 Patients and Methods: The trial is designed to enrol 250 patients presenting with acute
 dyspnea to physicians in private practice. Patients will be randomly assigned 1:1 into a
 control group using evaluation of patients according to local standards without the use of
 BNP (or other natriuretic peptides) and to a BNP group with early testing for BNP by a rapid
 point-of-care assay during the first consultation in each private practice.

 Expected results: It is the researchers' hypothesis that a BNP guided diagnostic strategy
 will improve the evaluation and management and thereby reduce total cost of diagnosis and
 treatment.

 Significance: Given the significant morbidity associated with dyspnea, as well as the
 enormous expenses associated with heart failure and pulmonary disease, BNP testing could
 represent a major advance in clinical medicine. In addition, BNP testing in the appropriate
 clinical setting may prove very helpful in the attempts to reduce cost of health care to
 society without reducing (but possibly increasing) the quality of health care.
Inclusion Criteria:

 -  Acute dyspnoea is the main symptom

 Exclusion Criteria:

 -  Age <18 years

 -  Obvious traumatic cause

 -  Severe renal dysfunction (serum creatinine > 250 umol/l)

 -  Sepsis