In the “Breathing Not Properly Multinational Study,” in 1,586 ED patients presenting with acute shortness of breath, BNP levels measured on arrival had higher diagnostic accuracy than did the ED physician in diagnosing HF, with an area under the receiver-operating characteristic curve (AUC) of 0.90. Incorporation of B-type natriuretic peptide (BNP) measurements when triaging patients presenting with shortness of breath has improved the diagnostic and prognostic ability of treating physicians. Due to the alarming costs of HF, there is an urgent need to detect patients at risk of developing HF and establishing timely therapy to prevent irreversible changes that can lead to chronic HF. 4 The “gold standard” for diagnosis is echocardiography, which is not generally available in the emergency setting. 3 Furthermore, a misdiagnosis in the emergency department (ED) could place a dyspneic patient at increased risk for both morbidity and mortality. 2 While the most common disease group in patients over 65 is HF, 2 it remains difficult to diagnose due to a lack of sensitive and specific presenting symptoms. The economic burdens of HF are caused by the high number of hospital admissions for initial treatment and high costs of long term care for these patients. The number of HF-related hospital admissions has been steadily rising in developed countries. 1 With improving diagnosis and management of acute myocardial infarction and HF, it is likely this cost will continue to increase over time. 1 The estimated direct and indirect cost of HF in the U.S. About five million Americans have this disease, and approximately 550,000 new cases are identified each year. Heart failure (HF) is one of the leading causes of death in the U.S.
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