The test for heart failure with the highest sensitivity (94%) and specificity (70%) is clinical suspicion combined with a brain natriuretic peptide (BNP) concentration > 100 pg/ml.¹ BNP concentration is also an independent predictor of mortality in heart failure.² However, its value in predicting mortality compared with other traditional clinical findings and laboratory parameters has not been reported. This study compared the prediction of heart failure mortality within 30 days by BNP concentrations with a predictive model based on classic clinical findings recently described by Lee et al.³

METHODS

Nenagh Hospital is small general hospital in rural Ireland. From 29 September 2000 to 22 January 2002, 3692 patients were admitted to the hospital’s 36-bed acute medical unit. BNP was measured in 646 (17.5%) of these patients. The selection of patients for BNP determination was based on the clinical estimate of the likely presence of heart failure. No specific instructions for measuring BNP were issued to the medical staff other than to obtain a concentration if heart failure was suspected. BNP concentrations were measured with the Triage BNP test (Biosite Diagnostics, La Jolla, California, USA). Four hundred and twenty-two patients had BNP concentrations > 100 pg/ml. Twelve patients were excluded because of incomplete data, leaving a final …