Luc W Eurlings1, Sandra Sanders-van Wijk2, Dave J W van Kraaij3, Roland van Kimmenade4, Joan G Meeder5, Otto Kamp6, Marja P van Dieijen-Visser7, Jan G P Tijssen8, Hans-Peter Brunner-La Rocca2, Yigal M Pinto8. 1. Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands. Electronic address: leurlings@gmail.com. 2. Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands. 3. Department of Cardiology, Orbis Medical Center, Sittard, The Netherlands. 4. Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands. 5. Department of Cardiology, Viecuri Medical Center, Venlo, The Netherlands. 6. Department of Cardiology, VU Medical Center, Amsterdam, The Netherlands. 7. Department of Clinical Chemistry, Maastricht University Medical Center, Maastricht, The Netherlands. 8. Department of Cardiology, Heart Failure Research Center, Academic Medical Center, Amsterdam, The Netherlands.
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.
RCT Entities:
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.
Authors: Christopher S Lee; Quin E Denfeld; Bradley E Aouizerat; Corrine Y Jurgens; Christopher V Chien; Emily Aarons; Jill M Gelow; Shirin O Hiatt; James O Mudd Journal: Heart Lung Date: 2018-10-09 Impact factor: 2.210
Authors: Julie McLellan; Carl J Heneghan; Rafael Perera; Alison M Clements; Paul P Glasziou; Karen E Kearley; Nicola Pidduck; Nia W Roberts; Sally Tyndel; F Lucy Wright; Clare Bankhead Journal: Cochrane Database Syst Rev Date: 2016-12-22