H R Omar1, M Guglin2. 1. Internal Medicine Department, Mercy Medical Center, Clinton, IA, USA. hesham_omar2003@yahoo.com. 2. Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
Abstract
BACKGROUND: The B‑type natriuretic peptide (BNP) level on discharge of patients hospitalized with decompensated heart failure (HF) is widely considered as the "baseline" value, and treatment should be targeted to maintain this level. The prognostic value of an increase in BNP level from discharge to the 1‑month follow-up in predicting rehospitalization has not been previously explored. METHODS: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial data were utilized to determine whether an increase in BNP level from discharge to the 1‑month follow-up is associated with a higher risk of rehospitalization. The study endpoints were all-cause rehospitalization up to 6 months following randomization. RESULTS: Among 44 patients (mean age, 56 years, 71% men) who had their BNP levels checked on discharge and at the 1‑month follow-up, the average BNP level on discharge of the whole cohort was 467 pg/ml, which increased to 919 pg/ml at 1 month (p = 0.001). The median and interquartile range of the magnitude of rise in BNP level from discharge to 1‑month follow-up was higher in rehospitalized compared with non-rehospitalized patients (329 [11, 956] vs. 44 [-90, 316] pg/ml, p = 0.039, in both groups, respectively). Receiver operator characteristic curves showed that the magnitude of the rise in BNP from discharge to the 1‑month follow-up had an area under the curve of 0.686 (p = 0.0255) in predicting all-cause rehospitalization. Rehospitalized and non-rehospitalized patients had similar degree of clinical congestion and comparable BNP level on hospital discharge. CONCLUSION: The magnitude of the rise in BNP level from discharge to the 1‑month follow-up is a useful prognostic factor that predicts rehospitalization in patients with HF.
BACKGROUND: The B‑type natriuretic peptide (BNP) level on discharge of patients hospitalized with decompensated heart failure (HF) is widely considered as the "baseline" value, and treatment should be targeted to maintain this level. The prognostic value of an increase in BNP level from discharge to the 1‑month follow-up in predicting rehospitalization has not been previously explored. METHODS: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial data were utilized to determine whether an increase in BNP level from discharge to the 1‑month follow-up is associated with a higher risk of rehospitalization. The study endpoints were all-cause rehospitalization up to 6 months following randomization. RESULTS: Among 44 patients (mean age, 56 years, 71% men) who had their BNP levels checked on discharge and at the 1‑month follow-up, the average BNP level on discharge of the whole cohort was 467 pg/ml, which increased to 919 pg/ml at 1 month (p = 0.001). The median and interquartile range of the magnitude of rise in BNP level from discharge to 1‑month follow-up was higher in rehospitalized compared with non-rehospitalized patients (329 [11, 956] vs. 44 [-90, 316] pg/ml, p = 0.039, in both groups, respectively). Receiver operator characteristic curves showed that the magnitude of the rise in BNP from discharge to the 1‑month follow-up had an area under the curve of 0.686 (p = 0.0255) in predicting all-cause rehospitalization. Rehospitalized and non-rehospitalized patients had similar degree of clinical congestion and comparable BNP level on hospital discharge. CONCLUSION: The magnitude of the rise in BNP level from discharge to the 1‑month follow-up is a useful prognostic factor that predicts rehospitalization in patients with HF.
Authors: Marta Kałużna-Oleksy; Filip Sawczak; Agata Kukfisz; Helena Krysztofiak; Magdalena Szczechla; Marta Wleklik; Katarzyna Przytarska; Magdalena Dudek; Alicja Nowak; Ewa Straburzyńska-Migaj; Bartosz Uchmanowicz Journal: Int J Environ Res Public Health Date: 2021-11-26 Impact factor: 3.390
Authors: Nadia Aspromonte; Luigi Cappannoli; Pietro Scicchitano; Francesco Massari; Ivan Pantano; Massimo Massetti; Filippo Crea; Roberto Valle Journal: J Clin Med Date: 2021-05-14 Impact factor: 4.241