BNP Therapy Observation Unit Outcomes STudy (BOOST)

Congestive heart failure (CHF) is a growing problem in the United States. The increasing
number of decompensated heart failure patients presenting to Emergency departments (ED) for
treatment is worsening the burden on already strained and limited health care resources. In
addition, many of these patients will return to the ED for treatment within three months of
being treated for decompensated heart failure. The emergence of ED observation units has
provided a viable and cost effective alternative to inpatient treatment for many diseases
including CHF. It has been shown that intensive, directed therapy in ED observation units
has decreased the revisit rates for CHF patients. In addition, the introduction of
natriuretic peptide therapy has shown promising results in the treatment of decompensated
congestive heart failure.

We hypothesize that patients admitted to an ED observation unit will have a decreased rate
of hospital admissions and ED recidivism when treated with natriuretic peptides versus
standard therapy. We also hypothesize that decreasing B-type Natriuretic Peptide levels
during treatment in an ED observation unit will predict these patient outcomes.

The primary aim of this study is to compare natriuretic peptide therapy versus standard
heart failure therapy in an ED setting. A secondary aim is to determine if serial BNP
levels during this observation unit stay will predict clinical outcomes.

The treatment of heart failure in the ED places a tremendous burden on already limited
resources. The costs of treatment as well as the morbidity and mortality associated with
the disease are worsening and are predicted to increase as the general population ages. The
ability to safely treat and discharge patients from an ED observation unit while reducing
return visits would be invaluable in managing the growing number of heart failure patients.

Inclusion Criteria:

- Adult patient > 18 years of age

- Have a working diagnosis of HF, as determined by the emergency physician using the
Boston Criteria. A score of 8-12 is required for inclusion in the study.

- Alert, oriented and able to provide informed consent.

- Able to be contacted by telephone for follow up after discharge, and have none of the
study exclusion criteria.

Exclusion Criteria:

- Dialysis Dependent Renal Failure

- Fever, T>38.5C

- Pneumonia (Infiltrates on Chest X-ray)

- Requiring IV vasoactive agents (Other than Nesiritide)

- Killip Class III/IV

- Systolic blood pressure < 90 mmHg

- EKG diagnostic or suggestive of Acute MI or Ischemia

- Abnormal Cardiac Markers

- Lack of a telephone

- Inability to provide informed consent due to cognitive impairment or a severe
psychiatric disorder