Rapid Emergency Department Heart Failure Outpatients Trial - REDHOT II


The goal of the trial was to evaluate management with serial B-type natriuretic peptide (BNP) measurements compared with limited BNP measurements performed at physician discretion, among patients admitted with acute heart failure.


The use of serial BNP measurements would improve clinical outcomes.

Study Design

Study Design:

Patients Screened: 480
Patients Enrolled: 447
Mean Follow Up: 30 days
Mean Patient Age: 64 years
Female: 49%

Patient Populations:

  • Patients at least 18 years of age who were admitted with acute heart failure


  • BNP level <100 pg/ml
  • Acute coronary syndrome
  • Hemodialysis
  • Patients enrolled in another investigational study

Primary Endpoints:

  • Hospital length of stay

Secondary Endpoints:

  • In-hospital mortality
  • 30-day mortality
  • 30-day readmission rate

Drug/Procedures Used:

Patients admitted with acute heart failure were randomized to serial point-of-care BNP measurements at baseline, 3, 6, 9, and 12 hours (n = 228) versus usual care where BNP was measured according to treating physician’s discretion (n = 219).

Concomitant Medications:

During admission, in the serial BNP group, the use of angiotensin-converting enzyme inhibitors was 66%, diuretics 93%, calcium antagonists 30%, beta-blockers 71%, and alpha-blockers 5.2%.

Principal Findings:

Overall, 447 patients were randomized. The mean age was 64 years and 49% were women. The initial BNP level was 1189 pg/ml in the serial BNP group and 1096 pg/ml in the control BNP group. BNP decreased to 747 pg/ml at discharge in the serial BNP group.

The length of stay was 6.5 days in the serial BNP group versus 6.5 days in the control group (p = 0.94). In-hospital mortality was 2.2% versus 3.2% (p = 0.51), 30-day mortality was 3.7% versus 5.5% (p = 0.42), and rehospitalization was 20.2% versus 23.7% (p = 0.43), respectively.


Among patients admitted with acute heart failure, serial BNP measurements did not appear to be of clinical benefit. This approach did not reduce length of hospital stay, in-hospital mortality, 30-day mortality, or rehospitalization compared with limited measurement of BNP.

While initial measurement of BNP among patients with signs and symptoms of heart failure carries diagnostic and prognostic information, serial BNP measurements to direct and possibly escalate care, do not appear to improve clinical outcomes.


Singer AJ, Birkhahn RH, Guss D, et al. Rapid emergency department heart failure outpatients trial (REDHOT II): a randomized controlled trial of the effect of serial BNP testing on patient management. Circ Heart Fail 2009;May 19:[Epub ahead of print].

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Hospital Mortality, Heart Failure, Length of Stay, Natriuretic Peptide, Brain

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