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Original Articles

Rapid Emergency Department Heart Failure Outpatients Trial (REDHOT II)

A Randomized Controlled Trial of the Effect of Serial B-Type Natriuretic Peptide Testing on Patient Management

Adam J. Singer, MD; Robert H. Birkhahn, MD; David Guss, MD; Abhinav Chandra, MD; Chadwick D. Miller, MD; Brian Tiffany, MD; Phillip Levy, MD, MPH; Robert Dunne, MD; Aveh Bastani, MD; Henry C. Thode, Jr, PhD and Judd E. Hollander, MD

From the Department of Emergency Medicine (J.E.H.), University of Pennsylvania, Philadelphia, Pa; Department of Emergency Medicine (A.J.S., H.C.T.), Stony Brook University, Stony Brook, NY; Department of Emergency Medicine (R.H.B.), New York Methodist Hospital, New York, NY; Department of Emergency Medicine (D.G.), University of California at San Diego, Calif; Department of Emergency Medicine (A.C.), Duke University, Durham, NC; Department of Emergency Medicine (C.D.M.), School of Medicine, Wake Forrest University, Winston-Salem, NC; Department of Emergency Medicine (P.L.), Wayne State University, Detroit, Mich; Department of Emergency Medicine (R.D.), University of Michigan, Ann Arbor, Mich; Department of Emergency Medicine (B.T.), Chandler Regional Hospital, Chandler, Ariz; Department of Emergency Medicine (R.D.), Sinai Grace Hospital, Detroit, MI; and Department of Emergency Medicine (A.B.), Troy Beaumont Hospital, Troy, Mich.

Correspondence to Adam J. Singer, MD, Department of Emergency Medicine, HSC L4-080, Stony Brook, NY 11794-8350. E-mail adam.singer{at}stonybrook.edu

Received October 7, 2008; accepted April 2, 2009.

Background— B-type natriuretic peptide is useful to diagnose heart failure. We determined whether the use of serial B-type natriuretic peptide measurements to guide treatment improves the outcome in patients with acute heart failure.

Methods and Results— We conducted a randomized controlled trial of patients with acute heart failure in 10 academic and community emergency departments. The experimental group received serial B-type natriuretic peptide testing (at 3, 6, 9, and 12 hours then daily). The control group received usual care. Our outcomes were hospital length of stay, 30-day readmission rate, and all-cause mortality.

There were 219 controls and 228 experimental patients. Mean age was 64 years, 49% were women, 58% were blacks, and 34% were whites. Groups were similar in baseline characteristics. Comparing the serial testing with the control group, there was no difference in length of stay (6.5 days [95% CI, 5.2 to 7.9] versus 6.5 days [95% CI, 5.6 to 7.3]; difference, 0.1 [95% CI, –1.7 to 1.5]), in-hospital mortality (2.2% [95% CI, 0.9 to 5.0] versus controls, 3.2% [95% CI, 1.6 to 6.5]; difference, 1.0% [95% CI, –2.3 to 4.5]), 30-day mortality (3.7% [95% CI, 1.8 to 7.5] versus 5.5% [95% CI, 3.0 to 9.8]; difference, 1.8% [95% CI, –2.8 to 6.5]), or hospital revisit rate (20.2% [95% CI, 15.0 to 26.6] versus 23.7% [95% CI, 18.0 to 30.6]; difference, 3.5% [95% CI, –5.1 to 12.1]).

Conclusions— In this study of 447 patients hospitalized for suspected heart failure, we were unable to demonstrate a benefit of serial testing with B-type natriuretic peptide in terms of hospital length of stay, mortality, or readmission rate.

Key Words: acute heart failure • B-type natriuretic peptide • point-of-care testing • mortality

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CLINICAL PERSPECTIVE

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