Department of Cardiology, Wollongong Hospital, Wollongong, NSW, Australia.
Department of Cardiology, Wollongong Hospital, Wollongong, NSW, Australia.
Heart Lung Circ. 2023 Oct;32(10):1215-1221. doi: 10.1016/j.hlc.2023.08.008. Epub 2023 Sep 23.
N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a cardiac biomarker with diagnostic and prognostic utility in patients with heart failure (HF). Whether NT-proBNP can be used to triage inpatient transthoracic echocardiogram (TTE) requirements, and whether this impacts hospital length of stay (LOS), is not clear.
Clinical and biochemical data were prospectively recorded on all inpatients at Wollongong Hospital, NSW, Australia, who had a TTE ordered for suspected HF over a 6-month period. NT-proBNP was used to triage TTE priority, where high-priority inpatient TTE, lower-priority inpatient TTE and outpatient (OP) TTE were performed for serum NT-proBNPs of ≥900, 300-899 and <300, respectively. Outcomes were compared with a baseline cohort of HF inpatients in whom TTE requirement was not guided by NT-proBNP.
A total of 236 patients were evaluated-31, 31, and 174 in the low, intermediate and high NT-proBNP cohorts, respectively, and 199 patients were in the baseline cohort. Average hospital LOS was significantly reduced in the study cohort compared to baseline (9.97 vs 13.87 days, p<0.001). Of the 31 patients with a very low NT-proBNP who were discharged for OP TTE, seven were readmitted within 30 days, though none were HF-related. There were no deaths at 30 days in the low or intermediate NT-proBNP groups.
Using NT-proBNP to triage requirements for inpatient TTE reduces hospital LOS. A very low NT-proBNP may help identify which patients with suspected HF can be safely discharged for OP TTE.
N 端脑利钠肽前体（NT-proBNP）是心力衰竭（HF）患者具有诊断和预后价值的心脏生物标志物。NT-proBNP 是否可用于分诊住院经胸超声心动图（TTE）的需求，以及这是否会影响住院时间（LOS）尚不清楚。
在澳大利亚新南威尔士州卧龙岗医院，对所有在 6 个月期间因疑似 HF 而接受 TTE 检查的住院患者，前瞻性地记录了临床和生化数据。使用 NT-proBNP 对 TTE 进行优先级分诊，其中高优先级住院患者 TTE、低优先级住院患者 TTE 和门诊（OP）TTE 分别用于血清 NT-proBNP≥900、300-899 和<300。结果与未根据 NT-proBNP 指导 TTE 需求的 HF 住院患者的基线队列进行了比较。
共评估了 236 例患者，低、中、高 NT-proBNP 组分别为 31、31 和 174 例，基线组为 199 例。与基线相比，研究组的平均住院 LOS 显著缩短（9.97 天 vs 13.87 天，p<0.001）。在接受 OP TTE 出院的 31 例 NT-proBNP 非常低的患者中，有 7 例在 30 天内再次入院，但均与 HF 无关。在低或中 NT-proBNP 组中，30 天内无死亡。
使用 NT-proBNP 分诊住院 TTE 的需求可缩短住院时间。非常低的 NT-proBNP 可能有助于确定哪些疑似 HF 患者可以安全出院接受 OP TTE。
