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Sites were selected on the basis that patients could directly present to primary care physicians as a first point of consultation. Physicians were eligible if they saw patients as their primary contacts or as referrals from other physicians. Thus, the participating physicians represented a range of medical background from general practitioners to physicians with additional training in internal medicine, pneumology and cardiology. A total of 323 consecutive patients were enroled in the study. Participating practices were equally distributed in urban and suburban areas. Eligible patients presented with dyspnoea as their primary symptom. Dyspnoea had to be of new onset or clearly worsening if pre-existing. If multiple symptoms were present in an individual patient, dyspnoea had to be the main symptom. Patients younger than 18?years of age, or with an obvious traumatic cause of http://www.selleckchem.com/products/AZD1152-HQPA.html dyspnoea, severe renal disease [defined by a serum creatinine level of more than 250?��mol?L?1 (2.8?mg?dL?1)] or sepsis were excluded. The primary care physicians independently evaluated and treated the http://en.wikipedia.org/wiki/MRIP patients and determined the initial diagnosis on the day of presentation. The study investigators were not involved in patient care and had no influence on diagnostic procedures or treatment decisions. Group assignment in a 1?:?1 ratio was accomplished using a computer-generated randomization scheme stratified by site. Patients were randomly assigned to an evaluation using a diagnostic strategy that included the rapid point-of-care measurement of BNP levels at initial presentation (BNP group) or to an evaluation using the conventional diagnostic strategy without the measurement of BNP (control group). Owing to the differences in the extent and type of diagnostic testing available to the physicians at different sites, the protocol did not mandate a specific sequence of diagnostic testing. Measurement of BNP during follow-up was discouraged in both groups. All patients underwent an initial clinical assessment that, in general, included http://www.selleckchem.com/products/pf-06463922.html a clinical history, a physical examination and electrocardiography. Chest radiography and pulmonary function tests were performed based on clinical decision. During the initial evaluation, a venous blood sample (3?mL) was collected in a tube containing potassium EDTA. Within a 15-min period, BNP was measured using a rapid fluorescence immunoassay (Biosite Diagnostics, La Jolla, CA, USA). The same assay was used at all participating centres. The precision, analytical sensitivity and stability characteristics of the system have been described previously [16]. In brief, it has been reported that the coefficient of variation for intra-assay precision is 10%, 12% and 14%, and the coefficient of variation for interassay precision is 10%, 12% and 15% for BNP levels of 29, 584 and 1180?ng?L?1, respectively [17]. The analytical sensitivity was