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Plasma BNP measurements at discharge predict outcomes in acute HF
Plasma B-type natriuretic peptide measured at discharge in patients with acute HF predicted long-term outcomes, but its effect was weakened in those with HF with midrange ejection fraction and preserved ejection fraction, according to a study published in The American Journal of Cardiology.
Yasuhiro Hamatani, MD, of the department of cardiovascular medicine at the National Cerebral and Cardiovascular Center in Osaka, Japan, and colleagues analyzed data from 1,792 patients (mean age, 73 years; 62% men) from the WET-HF and NaDEF trials. Information on treatment, baseline demographics, laboratory parameters and clinical outcomes were included in the analysis. Plasma B-type natriuretic peptide (BNP) levels were measured in these patients on admission and at discharge.
Patients were categorized based on their left ventricular ejection fraction: HF with reduced ejection fraction (LVEF < 40%; n = 860), HF with midrange ejection fraction (LVEF 40%-50%; n = 318) and HFpEF (LVEF > 50%; n = 614).
The primary outcome was all-cause death, and the secondary outcome was a composite of HF rehospitalization or all-cause death after the index admission.
During a median follow-up of 664 days, the primary outcome of all-cause death occurred in 19% of patients, and the secondary outcome was seen in 39% of patients.
Plasma BNP measurements at discharge had the highest c-index (0.69; P < .001) compared with measurements at admission or change during hospitalization.
There was a significant interaction between discharge plasma BNP and mortality in patients with HFrEF (HR = 1.95; 95% CI, 1.57-2.41), HF with midrange ejection fraction (HR = 1.76; 95% CI, 1.1-2.82) and HFpEF (HR = 1.46; 95% CI, 1.12-1.91; P for interaction = .011).
Discharge plasma BNP for mortality in patients with HFrEF had a higher c-index (0.72; 95% CI, 0.68-0.76) compared with those with HF with midrange ejection fraction (0.68; 95% CI, 0.6-0.75) and HFpEF (0.65; 95% CI, 0.6-0.7).
The composite of HF rehospitalization or mortality had similar results, although the interaction among HF phenotypes was not statistically significant.
“In the current investigation, we confirmed that discharge BNP was the strongest prognostic parameter with statistical significance in a large-scale prospective [acute] HF dataset with a longer follow-up period, suggesting that measurement of discharge BNP could be important for predicting long-term adverse outcomes in hospitalized patients with [acute] HF,” Hamatani and colleagues wrote. – by Darlene Dobkowski
Disclosures: Hamatani reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.