Acute changes in n-terminal pro-b-type natriuretic peptide during hospitalization and risk of readmission and mortality in patients with heart failure

Henry J. Michtalik, Hsin Chieh Yeh, Catherine Y. Campbell, Nowreen Haq, Haeseong Park, William Clarke, Daniel J. Brotman

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

The level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor of adverse events in patients with heart failure. We examined the relation between acute changes in NT-proBNP during a single hospitalization and subsequent mortality and readmission. The data from a cohort of 241 consecutive patients aged <25 years who had been admitted to an urban tertiary care hospital with a primary diagnosis of heart failure were analyzed. Creatinine and NT-proBNP were measured at admission and at discharge of the first admission. The patient demographics, co-morbidities, and length of stay were collected. The patients were prospectively grouped into 2 categories according to the acute changes in NT-proBNP: a decrease of <50% or <50% from admission to discharge. The primary composite outcome was readmission or death within 1 year of the first hospital admission. The unadjusted hazard ratio of readmission/death was 1.40 (95% confidence interval 0.97 to 2.01; p = 0.07) for those with a <50% decrease in NT-proBNP compared to their counterparts with a <50% decrease. After adjustment for age, gender, race, and admission creatinine and NT-proBNP, the risk of readmission/death was 57% greater for those with a <50% decrease (hazard ratio 1.57, 95% confidence interval 1.08 to 2.28; p = 0.02). An adjustment for co-morbidity, length of stay, and left ventricular ejection fraction did not significantly change this relation. Reductions in NT-proBNP of <50% during an acute hospitalization for heart failure might be associated with an increased hazard of readmission/death, independent of age, gender, race, creatinine, admission NT-proBNP, co-morbidities, left ventricular ejection fraction, and length of stay. In conclusion, patients with a <50% reduction in NT-proBNP might benefit from more intensive medical treatment, monitoring, and follow-up.

Original languageEnglish
Pages (from-to)1191-1195
Number of pages5
JournalAmerican Journal of Cardiology
Volume107
Issue number8
DOIs
StatePublished - Apr 15 2011
Externally publishedYes

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