N-Terminal–Pro-Brain Natriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients

Abstract

Background-Heart failure (HF) is responsible for a huge burden in hospital care. Our goal was to evaluate the value of N-terminal-pro-brain natriuretic peptide (NT-proBNP) in predicting death or hospital readmission after discharge of HF patients. Methods and Results-We included 182 patients consecutively admitted to hospital because of decompensated HF.Patients were followed up for 6 months. The primary end point was death or readmission. Twenty-six patients died in hospital. The median admission NT-proBNP level was 6778.5 pg/mL, and the median level at discharge was 4137.0 pg/mL (PϽ0.001). Patients were classified into 3 groups: (1) decreasing NT-proBNP levels by at least 30% (nϭ82), (2) no significant modifications on NT-proBNP levels (nϭ49), and (3) increasing NT-proBNP levels by at least 30% (nϭ25). The primary end point was observed in 42.9% patients. Variables associated with an increased hazard of death and/or hospital readmission in univariate analysis were length of hospitalization, heart rate, signs of volume overload, no use of ACE inhibitors, higher NYHA class at discharge, admission and discharge NT-proBNP, and the change in NT-proBNP levels. The variation in NT-proBNP was the strongest predictor of an adverse outcome. Independent variables associated with an increased risk of readmission or death were signs of volume overload and the change in NT-proBNP levels. Conclusions-Variations in NT-proBNP levels are related to hospital readmission and death within 6 months. NT-proBNP levels are potentially useful in the evaluation of treatment efficacy and might help clinicians in planning discharge of HF patients. Whether therapeutic strategies aimed to lower NT-proBNP levels modify prognosis warrants future investigation.

Association between Survival Time and Changes inNT‐proBNPin Cats Treated for Congestive Heart Failure

“…In studies of people with CHF, a decrease in BNP >30% during hospitalization predicted a 45% decrease in mortality risk or >40% survival advantage 24. In addition, another study in people with CHF showed that a >30% decrease in NT‐proBNP concentrations was associated with fewer adverse events, such as readmission for CHF or death within 6 months 29. In the current study, whereas BNP was not measured, achieving >30% decrease in NT‐proBNP concentrations was not associated with survival time in cats, although this may be related to the small sample size.…”

Evaluation of Plasma N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) Concentrations in Dogs with Mitral Valve Insufficiency

“…In humans, the plasma concentration of BNP is emphasized as a parameter of the severity of heart failure, a prognostic factor, and an item for evaluating the treatment response [15,16,18]. In addition, some studies have indicated that NT-proBNP is diagnostically more significant than BNP [3,5,6,10,11].…”

Interaction of Body Mass Index on the Association Between N‐Terminal‐Pro‐b‐Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure)

“…To our knowledge, this is the first investigation to assess the effect modification of BMI on the prognostic utility of NT‐proBNP levels on clinical outcomes in an acute HF population. Baseline and change in NT‐proBNP levels have been shown to be powerful prognostic factors in acute HF 32, 33, 34. With the prevalence of obesity rising in North America, as evidenced by 50% of patients in our study population categorized as obese and 16% severely obese, our analysis provides evidence that NT‐proBNP testing during acute HF exacerbation remains useful in patients with the highest or lowest BMIs.…”