Can We IMPROVE-CHF Management By Measuring Natriuretic Peptides?

Acute decompensated heart failure (ADHF) is a major public health problem throughout the world. In the United States alone, this condition accounts for >1 million hospitalizations annually, and it is likely that this number will increase in the future just as it has done over the past several decades.1 Although some progress has been made in reducing in-hospital death rates and length of hospital stay for ADHF, mortality and readmission rates over the 6-month period after discharge remain alarmingly high. In addition, costs of managing patients with ADHF are substantial, with ≈60% of all funds spent on heart failure being consumed during hospitalizations. Despite recognition of the importance of ADHF, however, there has been little progress in either defining universally accepted management strategies or generating new treatment approaches that alter these outcomes.Article p 3103 The use of biomarkers to detect risk, assess prognosis, and guide management of disease has been a major advance in the practice of medicine. Measurement of B-type natriuretic peptide (BNP) or the amino terminal fragment of the precursor protein (NT-proBNP) have been shown to be useful in detecting the presence of heart failure in dyspneic patients and in determining prognosis.2–4 Although measurement of these peptides is widely used, questions about whether the test results can effectively help guide management strategies and whether they lead to better outcomes at lower cost to the healthcare system have not been fully addressed.5,6 In this issue of Circulation , Moe and colleagues7 present results of the IMPROVE-CHF study in which they assess the incremental value of NT-proBNP levels in confirming the diagnosis of heart failure in patients who presented to the emergency department (ED) with dyspnea believed to be of cardiac origin and whether access to NT-proBNP levels leads to cost savings without compromising clinical …