Rapid Emergency Department Heart Failure Outpatients Trial (REDHOT II): A Randomized Controlled Trial of the Effect of Serial BNP Testing on Patient Management

Background —B-type natriuretic peptide (BNP) is useful to diagnose heart failure. We determined if use of serial BNP measurements to guide treatment improves the outcome in patients with acute heart failure (HF). Methods and Results —We conducted a RCT of patients with acute heart failure in 10 academic and community emergency departments. The experimental group received serial BNP testing (at 3, 6, 9, 12 hr then daily). The control group received usual care. Our outcomes were hospital length of stay (LOS), 30 day readmission rate and all cause mortality. There were 219 controls and 228 experimental patients. Mean age was 64, 49% were female, 58% were black, 34% were white. Groups were similar in baseline characteristics. Comparing the serial testing to the control group, there was no difference in LOS (6.5 days [95% CI, 5.2 to 7.9] vs. 6.5 [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] vs. 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], vs. 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] vs. 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 HF, we were unable to demonstrate a benefit of serial testing with BNP in terms of hospital length of stay, mortality or readmission rate.