B‐Type Natriuretic Peptide Predicts Postdischarge Prognosis in Elderly Patients Admitted Due to Cardiogenic Pulmonary Edema

Abstract

To examine the prognostic role of predischarge B-type natriuretic peptide (BNP) levels in elderly patients admitted to the hospital due to cardiogenic pulmonary edema, 203 patients consecutively admitted to the Heart Failure Unit of the Cardiology Department were retrospectively evaluated. The primary clinical end point selected was a combination of: 1) deaths; plus 2) readmissions to the hospital for heart failure in the 6 months after discharge. Thirty-one deaths (15.3%) and 44 readmissions for heart failure (21.7%) were recorded. Cox multivariate regression analysis confirmed that BNP cutoff values (identified on receiver-operated curve analysis) are the most accurate predictor of events. Hazard ratios (HRs) increased from the lowest, for BNP < or = 200 pg/mL (HR=1), through BNP 201-499 pg/mL (HR=2.3200; p=0.0174), to the highest, for BNP > or = 500 pg/mL (HR=3.6233; p=0.0009). This study demonstrates that BNP is useful in predischarge risk stratification of elderly patients with cardiogenic pulmonary edema.

Admission, Discharge, or Change in B-Type Natriuretic Peptide and Long-Term Outcomes

“…Other studies have had varied follow-up time and heterogeneous endpoints. Among the studies to examine admission and discharge BNP values, several have also found that predischarge BNP was the most important prognostic marker (8,12,14,26). For example, the largest single-center study by Logeart and colleagues (n=114) revealed discharge BNP was the most important predictor of 6-month outcomes.…”

Fall in readmission rate for heart failure after implementation of B-type natriuretic peptide testing for discharge decision: A retrospective study

“…Before implementation of B-type natriuretic peptide testing for discharge decision, we usually discharged patients when a clinical/instrumental finding of stability was achieved [16,17]. This finding was made if 6 criteria were simultaneously met: a) subjective improvement on the basis of NYHA class, or at least no orthopnoea, for refractory NYHA IV patients; b) 90 b systolic blood pressure b 120 mm Hg; c) heart rate b 100 bpm; d) pulse oxymetry in ambient air N 90%; e) diuresis N 1000 ml/day; f) improvement in fluid overload (normal hydration or slight hyper-or de-hydration on electrical impedance analysis) [18].…”

“…We used a Btype natriuretic peptide value of ≤250 pg/ml [19] or a reduction of ≥30% [20] with respect to admission to identify patients who could be discharged, provided that the favourable modifications in the neuro-hormone corresponded to the above mentioned clinical/instrumental finding of stability [16,17]. Patients with a B-type natriuretic peptide value of N 250 pg/ml, in the absence of a reduction of ≥30%, were given "aggressive" treatment, namely: a) increased diuretic treatment (up to 500 mg/day of furosemide), b) strict blood pressure and heart rate control: target valuesb 100 mm Hg (for systolic blood pressure) and b 80 bpm respectively), c) possible inclusion in the therapeutic regimen of i.v.…”

Comprehensive Review of the Relative Clinical Utility of B-Type Natriuretic Peptide and N-Terminal Pro-B-Type Natriuretic Peptide Assays in Cardiovascular Disease

“…In another study of 325 ED patients, BNP levels above 480 pg/mL could predict adverse outcomes with a sensitivity of 68% and a specificity of 88% and area under the ROC curve of 0.87 [62]. BNP assays have strong prognostic value in both elderly and diabetic patients [63,64] and may be a stronger predictor in women compared to men [65].…”