PMID- 15364340
OWN - NLM
STAT- MEDLINE
DCOM- 20041021
LR  - 20151119
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 44
IP  - 6
DP  - 2004 Sep 15
TI  - Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial 
      (REDHOT). A multicenter study of B-type natriuretic peptide levels, emergency 
      department decision making, and outcomes in patients presenting with shortness of 
      breath.
PG  - 1328-33
AB  - OBJECTIVES: The purpose of this study was to examine the relationships among 
      B-type natriuretic peptide (BNP) levels within the diagnostic range, perceived 
      congestive heart failure (CHF) severity, clinical decision making, and outcomes 
      of the CHF patients presenting to emergency department (ED). BACKGROUND: Since 
      BNP correlates with the presence of CHF, disease severity, and prognosis, we 
      hypothesized that BNP levels in the diagnostic range offer value independent of 
      physician decision making with regard to critical outcomes in emergency medicine. 
      METHODS: The Rapid Emergency Department Heart failure Outpatient Trial (REDHOT) 
      study was a 10-center trial in which patients seen in the ED with shortness of 
      breath were consented to have BNP levels drawn on arrival. Entrance criteria 
      included a BNP level >100 pg/ml. Physicians were blinded to the actual BNP level 
      and subsequent BNP measurements. Patients were followed up for 90 days after 
      discharge. RESULTS: Of the 464 patients, 90% were hospitalized. Two-thirds of 
      patients were perceived to be New York Heart Association (NYHA) functional class 
      III or IV. The BNP levels did not differ significantly between patients who were 
      discharged home from the ED and those admitted (976 vs. 766, p = 0.6). Using 
      logistic regression analysis, an ED doctor's intention to admit or discharge a 
      patient had no influence on 90-day outcomes, while the BNP level was a strong 
      predictor of 90-day outcome. Of admitted patients, 11% had BNP levels <200 pg/ml 
      (66% of which were perceived NYHA functional class III or IV). The 90-day 
      combined event rate (CHF visits or admissions and mortality) in the group of 
      patients admitted with BNP <200 pg/ml and >200 pg/ml was 9% and 29%, respectively 
      (p = 0.006). CONCLUSIONS: In patients presenting to the ED with heart failure, 
      there is a disconnect between the perceived severity of CHF by ED physicians and 
      severity as determined by BNP levels. The BNP levels can predict future outcomes 
      and thus may aid physicians in making triage decisions about whether to admit or 
      discharge patients. Emerging clinical data will help further refine 
      biomarker-guided outpatient therapeutic and monitoring strategies involving BNP.
FAU - Maisel, Alan
AU  - Maisel A
AD  - University of California-San Diego, Veterans Affairs Medical Center, San Diego, 
      California 92161, USA. amaisel@ucsd.edu
FAU - Hollander, Judd E
AU  - Hollander JE
FAU - Guss, David
AU  - Guss D
FAU - McCullough, Peter
AU  - McCullough P
FAU - Nowak, Richard
AU  - Nowak R
FAU - Green, Gary
AU  - Green G
FAU - Saltzberg, Mitchell
AU  - Saltzberg M
FAU - Ellison, Stefanie R
AU  - Ellison SR
FAU - Bhalla, Meenakshi Awasthi
AU  - Bhalla MA
FAU - Bhalla, Vikas
AU  - Bhalla V
FAU - Clopton, Paul
AU  - Clopton P
FAU - Jesse, Robert
AU  - Jesse R
CN  - Rapid Emergency Department Heart Failure Outpatient Trial investigators
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Biomarkers)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
CIN - J Am Coll Cardiol. 2004 Sep 15;44(6):1334-6. PMID: 15364341
MH  - Biomarkers/blood
MH  - Decision Making
MH  - Dyspnea/*etiology/metabolism/*therapy
MH  - *Emergency Service, Hospital
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*metabolism/mortality/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/*metabolism
MH  - *Outpatients
MH  - Patient Admission
MH  - Patient Discharge
MH  - Predictive Value of Tests
MH  - ROC Curve
MH  - Severity of Illness Index
MH  - Single-Blind Method
MH  - Statistics as Topic
MH  - Survival Analysis
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2004/09/15 05:00
MHDA- 2004/10/22 09:00
CRDT- 2004/09/15 05:00
PHST- 2004/02/12 00:00 [received]
PHST- 2004/06/01 00:00 [revised]
PHST- 2004/06/08 00:00 [accepted]
PHST- 2004/09/15 05:00 [pubmed]
PHST- 2004/10/22 09:00 [medline]
PHST- 2004/09/15 05:00 [entrez]
AID - S0735109704011489 [pii]
AID - 10.1016/j.jacc.2004.06.015 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2004 Sep 15;44(6):1328-33. doi: 10.1016/j.jacc.2004.06.015.