A-016 Changes of NT-proBNP during hospitalization predict 12-month outcomes in heart failure

Abstract

Clinicians need objective measures to guide discharge decisions for patients hospitalized with heart failure. N-terminal pro–B-type natriuretic peptide (NT-proBNP) has well-described prognostic value, and the change from admission to discharge may refine risk assessment. Prior work supports natriuretic peptide–guided management in chronic heart failure, motivating this evaluation in the inpatient setting. Subjects >18 years old presenting to the ED with a diagnosis of new onset or worsening HF were included and followed for up to 12 months. The primary outcome was a composite outcome, defined as the first occurrence of all-cause mortality, cardiac-related mortality, or heart-related hospitalization. NT-proBNP was measured with the Alere NT-proBNP assay for Alinity i at admission and, when available, at discharge. We classified patients by change in NT-proBNP between admission and discharge (>=30% decrease; <30% change [-30% to +30% change]; >=30% increase). Cox proportional hazards models estimated hazard ratios (HRs) of NT-proBNP change categories, with multivariable models adjusting for age, sex, body mass index, smoking, diabetes, hypertension, estimated glomerular filtration rate, and NYHA class. Event rates of the composite outcome were assessed by NT-proBNP change category. Of 840 adjudicated heart failure patients with admission results, 191 (22.7%) had discharge measurements and follow-up data. Compared to the reference group of >=30% decrease in NT-proBNP from admission to discharge, the unadjusted HR (95% CI) for a <30% change was 1.62 (1.04-2.52, P = 0.0315). For an increase >=30%, the unadjusted HR (95% CI) was 2.06 (1.11-3.83, P = 0.0228). The adjusted HRs (95% CI) were 1.50 (0.95-2.37, P = 0.0829) and 1.94 (0.97-3.87, P = 0.0604) for a <30% change and >=30% increase, respectively, compared to the reference group. Patients with >=30% decrease had the lowest event rate (46.0%). Patients with <30% change and >=30% increase had event rates of 61.2% and 75.0%, respectively. In patients hospitalized due to HF, NT-proBNP change from admission to discharge provides additional prognostic value to stratify 12-month risk of adverse events. Patients with greater NT-proBNP increases at discharge demonstrated significantly higher risk. Incorporating the change in NT-proBNP values from admission to discharge may aid in the identification of patients who need closer follow-up and therapy after leaving the hospital.