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Paper Chase 2 - BNP and NT-proBNP Discharge Thresholds for Acute DHF

Andrew Buelt, DO and Joe Weatherly, DO
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No me gusta!

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This study showed that getting patients to a pre-determined BNP level prior to discharge might affect re-admission rates.

 

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Jacob D., MD -

I have been taught in residency to get the BNP to help distinguish between a COPD vs CHF exacerbation. If it's >500, it's most likely CHF. Often times patients will be readmitted with the same BNP they were discharged with the last time, whether it be 250 or 500, which doesn't really tell us anything. Because of this, we have been taught to hit them hard with a diuretic to dry them out and get a "dry" or baseline BNP prior to discharge, so when the are re-admitted we have something to compare it to. I know it's just another surrogate marker and we should probably focus more on the symptoms, but I wanted to know what you guys thought of this practice?

Heidi J., MD -

Hi Jake -

This is an interesting question! Neda, Andrew and I have been chatting about it. What you are describing is not standard of care in our institutions (east coast community, VA, and academic hospitals). Our practice is to focus on pt symptoms and weight rather than BNP. Interestingly, other than the BNP done in the emergency department at admission, we don't typically re-order a BNP unless the clinical picture is changing. We've taken a cursory glance at the literature and do see that targeting a certain reduction in BNP is recommended by some. But, we're in no hurry to change our practices, particularly in light of this article that Joe and Andrew reviewed.

That's our **Primary Care RAP consensus statement!

Thanks for the great question,
Heidi
** of course, as you know, consensus statements are low quality evidence and should be taken with a grain of salt.

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My Gut Biome Told Me So Full episode audio for MD edition 174:19 min - 82 MB - M4AHippo Primary Care RAP May 2017 Summary 301 KB - PDF

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