Methods: A study was done of 1586 patients who visited the emergency with acute shortness of breath, dyspnea, and whose BNP level was measured with a bedside assay. The diagnosis of heart failure was confirmed by two indepen¬dent cardiologists.
Results: Dyspnea was caused by heart failure in 744 patients, 47%, with shortness of breath due to noncardiac causes; in 72 patients with a history of left ventricular dysfunction, 5%; and no finding of heart failure in 770 patients, 49%. The BNP levels were more accurate than historical or physical findings in establishing the diagnosis of heart failure. At a cut-off of 100 pg/ml, the diagnostic accuracy of BNP was 83%. A level of BNP less than 50 pg/ml indicates the absence of heart failure. Patients with the diagnosis of heart failure had mean BNP level results of 675 i 50 pg/ml.
B. Mueller et al.
Methods: A prospective randomized controlled study of 452 patients who presented to the emergency department with acute dyspnea. The study randomly assigned 225 patients to BNP assay and 227 were assessed by a physician. Primary end points were the time to discharge the total cost of treatment.
Results: The use of BNP measurements reduced the need for hospitalization and intensive care: 75% of patients in the BNP group were hospitalized versus 85% assessed by a physician. The mean time to discharge was 8 days and 11 days in the BNP and control groups, respectively. The total cost of treatment was $5410 and $7264 in the BNP and control group, respectively.

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