Lori B. Daniels, MD, FACC

I'm Dr. Lori Daniels. I'm a cardiologist at UC San Diego Medical Center and the Director of the Cardiovascular Intensive Care Unit. I specialize in general cardiology with a special interest in biomarkers and critical care cardiology.

Natriuretic peptides have a very important role in the inpatient, outpatient, and in the emergency department setting. In the emergency department, they're very useful for helping diagnose heart failure in patients who come in short of breath, and this is especially important, often, in patients who are older, where the physical exam findings, like distended neck veins, and the chest X-ray findings may be non-specific. In the inpatient setting, natriuretic peptides are very prognostic. They can help us assess a patient's risk of rehospitalization. And in the outpatient setting, when a patient presents with shortness of breath, low natriuretic peptide levels can help us distinguish a subset of patients who may not need echocardiogram and cardiovascular workup compared to patients with an elevated natriuretic peptide level, for whom giving cardiology involvement and echocardiogram can actually help reduce costs and be more cost-effective, reduce rehospitalization and mortality.

So, very useful to have natriuretic peptides in all three settings: the emergency department, the outpatient and the inpatient setting. If a finger stick point of care natriuretic peptide test were available, there's a lot of potential value it could bring to care in the emergency department. First and foremost, finger stick point of care testing is fast.

On average, a point of care test saves about one hour, compared to use of the central laboratory. And, in the emergency department, more than anywhere, time is critical. It's important to patients. Patients don't want their time wasted. And it's important to doctors in hospitals. Faster tests means we can get results quicker, get patients triaged quicker, get them out of the hospital, improve patient flow. So, it would free up a lot of rooms. Studies have also shown that point of care natriuretic peptide testing not only is less expensive, but it's more sensitive than the clinical exam alone. It's more efficient, because it's faster. It leads to less delay in treatment, and actually can lead to fewer return visits. The availability of a finger stick point of care natriuretic peptide test would come in very useful in the outpatient setting in cardiology clinics, and in primary care clinics for managing our heart failure patients.

As you know, a lot of patients sometimes come to clinic and have forgotten to get their labs, or, if they got them, sometimes they're more than a week old. It makes it difficult to make decisions when you're sitting face-to-face with the patient and have accurate, up to date information. If that point of care natriuretic peptide test were available, we could make decisions about uptitration of medications, and give accurate information to the patient without having to send them out, get labs, call them back over the next few days. So, it would be quite useful for managing our heart failure patients, where those natriuretic peptide levels are quite useful.

The global trend in unplanned heart failure hospital readmissions is not improving, despite a lot of attempts over the years to improve it, and it's possible that the use of a point of care natriuretic peptide test could help reverse this trend. By having a point of care natriuretic peptide test when we see patients in the clinic with real-time information, we might be able to catch decompensations earlier. And when we have them there in the clinic, we could potentially administer some IV diuretics or uptitrate their home doses before they get so decompensated that they require hospital admission.

Having that point of care test in the clinic might also help us be more aggressive about titrating up their neuro-horomonal blockade, their goal-directed medical therapies, that we know reduces hospital readmissions and mortalities. So, there's a lot of ways that use of a point of care natriuretic peptide test might help us for our heart failure patients in the outpatient setting.

So overall, a finger stick point of care natriuretic peptide test could be helpful in a lot of settings. In the emergency department, that finger stick point of care test could help make care more efficient in patients who might have heart failure.

In the outpatient setting, patients who are short of breath could be more quickly triaged to whether they need cardiology evaluation, or further imaging. And then our heart failure patients, that point of care finger stick natriuretic peptide test might be able to help us prevent readmissions, get them earlier treatment when they have signs of decompensation, and get them to their higher targeted levels of their important heart failure medications that can help reduce mortality in the long run.