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Would it be fair to say that that's transparent to the patient?
Riley: Patients who have been with our program for long term are aware of the new test and what we're trying to do, but that transition was tough. We try to keep our patients aware of what's going on and what we're monitoring. It doesn't mean they always understand, but they're at least aware when they talk that the labs have changed.
Dr. Nugent: It also helps with someone who's never been here before who may be thinking, "I'm going home, but I still feel terrible." I can go over all the data with them, I can show them that we don't think this is going on, or we don't think that is going on. We think they're safe to go home and that very much helps that discussion.
Discuss how you might be using it in patient discharge planning, in follow-up care planning or in outpatient or even outreach patient testing.
Riley: In outpatient management, it helps drive how frequently we have patients return for follow up visits and that helps keep them out of the hospital.
Has sufficient time passed to have clinical data points that reflect a positive trend toward cardiac outcomes?
Dr. Feld: The literature shows that the use of the marker has helped with the care of the patients and that readmission rates are decreasing.
How about anecdotally? Anything you're observing that would say we made the right decision switching over to NT-proBNP?
Dr. Nugent: I don't know if it's necessarily related to NT-proBNP or if we're just getting better at what we do. We don't admit nearly as many patients from the ER to the heart services as we used to. We're doing a better job of managing outpatients.
We've talked briefly about how the patient experience changed. You talked about how they're better educated, that frankly you're bringing more to the table in terms of what you're evaluating and how you're evaluating it. Can you give me anything beyond that relative to the patient's experience?
Dr. Nugent: We're more accurate in our diagnosing. It's easy for us to say, "You're a heart failure patient and it looks like you're a little bit worse than you were last time." I suppose if you went to a small hospital and they didn't have the assay, they'd be going solely on their clinical acumen. We wouldn't be any better than them without the marker.
Zaleski: Clinicians' confidence levels are higher; they know they are doing the right thing because of the test results.
Riley: And if you're sharing with them the laboratory results, they're going to leave feeling much more comfortable about that discharge because you're confident in it.
Is there anything else that you'd like to add about the conversion to NT-proBNP?
Dr. Feld: The conversion went fairly well. As we learn more about the assay and what it can do for us, the application is going to increase. Every day we see the usefulness of NT-proBNP.
Dr. Nugent: I'm all for having more information. It helps me make patient decisions. A snapshot of how the heart's looking right at that moment is key information. As Ron said, there are a lot of applications to be looked at because we're talking about the stress of the heart. It is going to help us with other heart diagnosis and I'm excited to see where it goes. We order the test for anyone who comes in with difficulty breathing when we're not 100 percent sure of the cause. So if you have an asthmatic come in, that individual probably won't get it, but if it's someone who is 46 or older, and they look like they're laboring to breathe and we don't know why, they're always going to get that NT-proBNP. If it comes back negative, it's not failure, but is there some other heart-related cause we're not looking at? Is there COPD? Is there asthma?
So you're ordering more tests than you did previously?
Dr. Nugent: For NT-proBNP, yes, but it's focused. It helps us to rule in/out heart failure.
It's proven especially helpful with patients who are unable to talk to us, whom we've already intubated and we may be looking for a reason why they can't breathe.
Riley: I spoke with one of our cardiologists when we did the conversion. Cardiologists are loyal to the tests they run, and they want to have the data to prove that the next one is going to be as accurate. So while the conversion has resulted in a positive, it was a little tough to get through. But they did and now they're at a point where they're very reliant on NT-proBNP.
See the full conversation here.
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