Test to predict cardiovascular risk in heart attack patients not yet appropriately used

BNP levels were greater among sub-groups of patients who were less likely to have BNP levels measured at all," Roe continued. "It appears that physicians were ordering tests for those patients who would already be considered at the highest risk of early mortality, such as those with congestive heart failure on hospital presentation. More randomized trials are needed to specifically identify those patients who should be tested and those who would benefit the most from this new test."

To understand more clearly how the BNP test is used in the U.S., Roe and his colleagues consulted the national quality improvement initiative known as CRUSADE, which stands for "Can Rapid risk stratification of UnStable Angina patients suppress aDverse outcomes with Early implementation of the ACC/American Heart Association (AHA) guidelines."

CRUSADE continuously gathers data from participating hospitals that treat patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) including patients with a certain type of heart attack known as non-ST-segment elevation myocardial infarction. These patients come to hospital emergency rooms with heart attack symptoms and are found to have chemical signs of heart muscle death and/or electrocardiogram tests showing areas of ischemia in the heart. About 1.3 million Americans are hospitalized each year with NSTE ACS.

During a 20-month period ending in 2004, 30,324 NSTE ACS patients were treated at 312 CRUSADE hospitals. A total of 19.4 percent of those patients had their BNP levels measured.

'The finding that one in five patients received the test is in line for something as new as this type of laboratory test," Roe. "However, at this point it is not being used in the right patients. It appears that the test is predominantly being ordered in older patients with a history of heart failure or signs of heart failure on presentation. These patients are already at a high risk of early mortality based upon

Contact: Richard Merritt
Duke University Medical Center

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