MedicalResearch.com Interview with:
Justin A. Ezekowitz, MBBCh MSc
Associate Professor, University of Alberta
Co-Director, Canadian VIGOUR Centre
Cardiologist and Director, Heart Function Clinic
Nariman Sepehrvand, MD
Research Fellow & Graduate Student
Mazankowski Alberta Heart Institute
University of Alberta Edmonton, Canada
Medical Research: What is the background for this study?
Dr. Ezekowitz: Major practice guidelines recommend the use of natriuretic peptide (NP) testing for diagnosing acute heart failure (HF) in emergency departments (ED). Despite these guidelines, the majority of healthcare regions all around the world (except for the United States and New Zealand) have restricted access to NP testing due to concerns over cost to healthcare systems. In the province of Alberta, Canada, however, a province-wide access to NP testing was provided for all EDs in 2012. This study investigates the factors that are related to the utilization of NP testing in EDs.
Medical Research: What are the main findings?
Dr. Ezekowitz: There was a substantial geographic variation in testing for NPs, despite having a single payer system and the universal availability of NP testing in Alberta. Several factors (including male sex, some comorbidities like prior heart failure, urban residence, type of care provider and ED clinical volume) influenced the utilization of testing for NPs in routine ED practice.
Interestingly, patients with heart failure who were tested for NPs at ED, had a higher rate of hospital admission and lower 7 day and 90 day repeat ED visit rates compared to those who were not tested.
Medical Research: What should clinicians and patients take away from your report?
Dr. Ezekowitz: For healthcare regions which are planning to introduce, extend or standardize their NP testing in the ED, the results of this study may help them to recognize and address the potential target groups (e.g. care providers who are more or less likely to order the test, patients groups that should be targeted for testing in the EDs, and particular hospital types). Also, testing for NPs is associated with more hospital admissions from ED, but with fewer repeat ED visits.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Ezekowitz: A more detailed cost analysis is needed to explore the effects of NP testing on the overall health system. As well, further research into optimizing testing strategies as part of a patient care pathway are needed in order to allow more health care systems (who may be ready to introduce NP testing) to do so in an efficient and cost-effective manner.
Factors associated with natriuretic peptide testing in patients presenting to emergency departments with suspected Heart Failure
Sepehrvand, Nariman et al.
Canadian Journal of Cardiology
Justin A. Ezekowitz, MBBCh MSc, & Nariman Sepehrvand, MD (2015). BNP Testing in Heart Failure Resulted in More ER Admissions But Fewer Repeat Visits MedicalResearch.com