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?3). Nine patients (6%) in the BNP group and 11 patients (7%) http://en.wikipedia.org/wiki/MRIP in the control group died during the 12?months of follow-up (Table?3). Of these 20 patients, seven in the BNP group and seven in the control group experienced heart failure. Amongst patients in the BNP group, BNP levels were considerably higher in patients who died (483?ng?L?1, IQR 226�C974) than in survivors (77?ng?L?1, IQR 27�C174, P? http://www.selleckchem.com/products/AZD1152-HQPA.html In this randomized controlled multicentre study, we examined the use of a BNP-guided strategy in the evaluation and management of patients presenting with dyspnoea to primary care physicians. We report five major findings. First, the additional use of BNP levels did not reduce total medical cost, the primary end-point of this study. This finding is in contrast to the observations in the ED setting in which the inclusion of BNP measurement resulted in considerable cost savings [8, 25�C27]. As the cost savings associated with the use of BNP in the ED were largely because of a reduction http://www.selleckchem.com/products/pf-06463922.html in hospitalizations and time to discharge, it was difficult for BNP to impact on cost-intensive management decisions because of the low rate of hospitalizations in this study. The effect of BNP testing on medical cost seems therefore to depend on the setting of its use. This conclusion is further supported by the finding of a lack of effect on medical cost in a randomized trial conducted in the intensive care setting [28]. Secondly, the use of BNP levels improved some of the secondary end-points including an increase in diagnostic certainty, resulting in a reduced need for further diagnostic work-up (45�C33%), and in an earlier initiation of appropriate treatment. Our results confirm the hypothesis that the additional use of BNP improves this important quality-of-care performance measure [29]. The benefit seemed to be mainly in avoiding long treatment delays as both groups had similar median values, but large differences in the 75th percentile. Primary care physicians depend on easy-to-use, point-of-care tests to guide their management and treatment decisions.