Risk stratification with the use of serial N-terminal pro-B-type natriuretic peptide measurements during admission and early after discharge in heart failure patients: post hoc analysis of the PRIMA study

Luc W Eurlings, Sandra Sanders-van Wijk, Dave J W van Kraaij, Roland van Kimmenade, Joan G Meeder, Otto Kamp, Marja P van Dieijen-Visser, Jan G P Tijssen, Hans-Peter Brunner-La Rocca, Yigal M Pinto

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Abstract

OBJECTIVE: The aim of this work was to assess the prognostic value of absolute N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration in combination with changes during admission because of acute heart failure (AHF) and early after hospital discharge.

BACKGROUND: In AHF, readmission and mortality rates are high. Identifying those at highest risk for events early after hospital discharge might help to select patients in need of intensive outpatient monitoring.

METHODS AND RESULTS: We evaluated the prognostic value of NT-proBNP concentration on admission, at discharge, 1 month after hospital discharge and change over time in 309 patients included in the PRIMA (Can PRo-brain-natriuretic peptide guided therapy of chronic heart failure IMprove heart fAilure morbidity and mortality?) study. Primary outcome measures were mortality and the combined end point of heart failure (HF) readmission or mortality. In a multivariate Cox regression analysis, change in NT-proBNP concentration during admission, change from discharge to 1 month after discharge, and the absolute NT-proBNP concentration at 1 month after discharge were of independent prognostic value for both end points (hazard ratios for HF readmission or mortality: 1.71, 95% confidence interval [CI] 1.13-2.60, Wald 6.4 [P = .011] versus 2.71, 95% CI 1.76-4.17, Wald 20.5 [P < .001] versus 1.81, 95% CI 1.13-2.89, Wald 6.1 [P = .014], respectively.

CONCLUSIONS: Knowledge of change in NT-proBNP concentration during admission because of AHF in combination with change early after discharge and the absolute NT-proBNP concentration at 1 month after discharge allows accurate risk stratification.

Original languageEnglish
Pages (from-to)881-90
Number of pages10
JournalJournal of Cardiac Failure
Volume20
Issue number12
DOIs
Publication statusPublished - Dec 2014

Keywords

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Biomarkers
  • Cause of Death
  • Disease Progression
  • Female
  • Heart Failure
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Natriuretic Peptide, Brain
  • Patient Admission
  • Patient Discharge
  • Peptide Fragments
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Risk Assessment
  • Sex Factors
  • Survival Analysis

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