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Background: B-type natriuretic peptide (BNP) represents a promising predictor of early (30 days) re-admission in patients with heart failure (HF) admitted to cardiology units. Whether BNP retains its predictive value in unselected patients admitted to general medical wards is unknown. Methods: We determined BNP levels on admission and pre-discharge in 100 consecutive patients (71 male, mean age 78F10 years) admitted to a general medical unit due to decompensated HF. Follow-up after discharge was 30 days. Results: Of the 100 patients, 86 had z1 comorbid conditions. Median BNP was 739 pg/ml on admission (25th-75th percentile 355-1333 pg/ ml, respectively), and 414 pg/ml pre-discharge (25th-75th percentile 220-696 pg/ml). Seventeen patients were re-admitted or died within 30 days. Patients with pre-discharge BNP values N75th percentile (696 pg/ml) had greater risk of re-hospitalisation, as compared to values V696 pg/ml (56% vs. 4%, respectively; pb0.001). Negative predictive value for this cut-off was 96%. BNP values N75th percentile were associated with a 15.0 independent relative hazard (RH) of early re-admission or death (95% CI 4.2-53.8; pb0.0001). The other independent predictor was a NYHA class zIII at discharge (RH 2.9; 95% CI 1.1-9.3; pb0.05). Conclusion: In a general medical unit, pre-discharge BNP levels were a strong independent predictor of early re-admission or death due to HF, irrespective of substantial comorbidity and advanced age.

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