Pre‐discharge B‐type natriuretic peptide predicts early recurrence of decompensated heart failure in patients admitted to a general medical unit

Verdiani, Valerio; Nozzoli, Carlo; Bacci, Francesca; Cecchin, A; Rutili, Maria Serena; Paladini, Stefanía; Olivotto, Iacopo

doi:10.1016/j.ejheart.2004.12.006

Cited by 44 publications

(26 citation statements)

References 32 publications

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“…This has been reported previously both in the hospital [6][7][8][14][15][16] as well as in the ambulatory setting [17][18][19]. Our data confirm these findings, showing that NTproBNP three months after discharge is a better prognostic marker than NT-proBNP at discharge.…”

Section: Discussionsupporting

confidence: 82%

Prognostic value of sequential measurements of amino‐terminal prohormone of B‐type natriuretic peptide in ambulatory heart failure patients

Moertl

Hammer

Huelsmann

et al. 2008

European J of Heart Fail

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Background: We evaluated the prognostic value of sequential NT-proBNP values in ambulatory heart failure patients after discharge, investigating whether the current value or the recent percent change is more important. Methods and results: In 166 patients, NT-proBNP was measured at discharge from heart failure hospitalisation and three months later. The combined endpoint of death or heart failure rehospitalisation was evaluated after a maximum of 18 months or at follow-up closure. During a mean observation time of 14 ± 4 months, 63 patients (38%) reached the endpoint. In multiple Cox analysis, NT-proBNP three months after discharge (NT-proBNP-3Mo) and NT-proBNP percent change (NT-proBNP-%change) were the only independent predictors of the endpoint among various clinical and laboratory variables. After definition of a high-(n = 83, 57% endpoints) and a low-NT-proBNP patient subgroup (n = 83, 19% endpoints) according to the median NT-proBNP-3Mo (1751 pg/ml), NT-proBNP-%change was the strongest predictor in the high-NT-proBNP subgroup. In the low-NT-proBNP subgroup, NT-proBNP-3Mo was the only independent predictor. Conclusions: In ambulatory heart failure patients, the prognostic value of sequential NT-proBNP measurements depends on the magnitude of the current NT-proBNP value. Recent percent changes in NT-proBNP provide important prognostic information in patients with high NTproBNP but not in patients with low NT-proBNP.

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Section: Discussionsupporting

confidence: 82%

Prognostic value of sequential measurements of amino‐terminal prohormone of B‐type natriuretic peptide in ambulatory heart failure patients

Moertl

Hammer

Huelsmann

et al. 2008

European J of Heart Fail

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“…These data also apply to NT-proBNP [52,53]. There is also substantial data indicating that elevated predischarge BNP and NT-proBNP levels portend increased morbidity and mortality after admission for ADHF [54,55]; this also applies to those with multiple comorbidities [56]. One large review of this prognostic data showed that an increase in BNP of 100 pg/ml was associated with an approximately 35% increase in the relative risk of death [45].…”

Section: Bnp and Congestive Heart Failurementioning

confidence: 92%

Interpretation of B-type natriuretic peptide in cardiac disease and other comorbid conditions

Burke

Cotts²

2007

Heart Fail Rev

102

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B-Type natriuretic peptide (BNP) is elevated in states of increased ventricular wall stress. BNP is most commonly used to rule out congestive heart failure (CHF) in dyspneic patients. BNP levels are influenced by age, gender and, to a surprisingly large extent, by body mass index (BMI). In addition, it can be elevated in a wide variety of clinical settings with or without CHF. BNP is elevated in other cardiac disease states such as the acute coronary syndromes, diastolic dysfunction, atrial fibrillation (AF), amyloidosis, restrictive cardiomyopathy (RCM), and valvular heart disease. BNP is elevated in non-cardiac diseases such as pulmonary hypertension, chronic obstructive pulmonary disease, pulmonary embolism, and renal failure. BNP is also elevated in the setting of critical illness such as in acute decompensated CHF (ADHF) and sepsis. This variation across clinical settings has significant implications given the increasing frequency with which BNP testing is being performed. It is important for clinicians to understand how to appropriately interpret BNP in light of the comorbidities of individual patients to maximize its clinical utility. We will review the molecular biology and physiology of natriuretic peptides as well as the relevant literature on the utilization of BNP in CHF as well as in other important clinical situations, conditions that are commonly associated with CHF and or dyspnea.

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“…Our study was not retailed to define the prognostic impact of each comorbidity but it is well known that renal failure, anemia and cognitive deficit are the worse prognostic factors of HF in an elderly population. 21,23 Also BNP or NT pro-BNP are powerful prognostic markers: above all their discharge values are good predictors of hospital readmission, [33][34][35] but their determination was uncommon in our study.…”

Section: Discussionmentioning

confidence: 99%

The heart failure in Internal Medicine in Tuscany: the SMIT Study

Verdiani

Panigada²,

Fortini³

et al. 2015

Ital J Med

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The incidence and prevalence associated with the growing age of population have made heart failure (HF) a new epidemic. In Italy most of HF patients are admitted to Internal Medicine Departments (IMD). We conducted a 30-day cross-sectional study involving patients with HF admitted to IMD of Tuscany. The aim of the study was to provide an updated snapshot of in-hospital management of HF in Tuscany and to analyze the differences in relation to the most recent guidelines. We have recruited 770 patients (M=45.4%) with a mean age of 82.5±8.9 years. Only 16.1% had a de novo HF. Most of them were re-admitted for decompensated HF. Hypertension and ischemic disease are the prevailing etiologies. HF alone was in less than 2%. 71.5% of patients had more than two comorbidities and 40.6% more than three concomitant diseases. The mean hospital stay (overall 8.6±5.5 days) correlated with the number of comorbidity. About 25% of patients had a creatinine clearance <30 mL/min. Nearly 50% of patients had atrial fibrillation but only the half was anti-coagulated. b-blockers, angiotensin converting enzyme-inhibitors (ACE-I) or angiotensin receptor blockers (ARB) were prescribed in about two-thirds of the subjects. Echocardiography was performed in 64.1% of patients. BNP or NT-pro BNP was tested in 67% at the hospital admission and in 18.3% at the discharge. At the discharge 50.1% of patients had loss of autonomy, 57% a polypharmacy prescription (≥8 classes of medicines) and 21.2% needed domiciliary oxygen therapy, but despite these critical points only 8% of the patients were transferred to long-term/intermediate care settings. In conclusion, the main characteristics of patients with HF admitted to IMD in Tuscany are the advanced age (the patients are old and very old) and the presence of multiple comorbidities (HF alone is a rarity indeed). The use of echocardiography and the pharmacological therapy with ACE-I, ARB, b-blocker and anti-aldosterone agents is wider than previous surveys, but some diagnostic, therapeutic and prognostic aspects are not similar to that recommended by the most recent HF guidelines. This survey underscores again some differences between HF trials world and HF real world, where the management is probably also driven by a clinical holistic approach. Correspondence: Valerio Verdiani, via Faccioli 15, 50145 Firenze, Italy. Tel.: +39.366.6581380 -Fax: +39.0564.48533. E-mail: verdiani@fastwebnet This work is licensed under a Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).

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Pre‐discharge B‐type natriuretic peptide predicts early recurrence of decompensated heart failure in patients admitted to a general medical unit

Cited by 44 publications

References 32 publications

Prognostic value of sequential measurements of amino‐terminal prohormone of B‐type natriuretic peptide in ambulatory heart failure patients

Prognostic value of sequential measurements of amino‐terminal prohormone of B‐type natriuretic peptide in ambulatory heart failure patients

Interpretation of B-type natriuretic peptide in cardiac disease and other comorbid conditions

The heart failure in Internal Medicine in Tuscany: the SMIT Study

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