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

• Published in: Journal of cardiac failure 2014-12, Vol.20 (12), p.881-890
• Main Authors: Eurlings, Luc W., MD, Sanders-van Wijk, Sandra, MD, van Kraaij, Dave J.W., MD, PhD, van Kimmenade, Roland, MD, PhD, Meeder, Joan G., MD, PhD, Kamp, Otto, MD, PhD, van Dieijen-Visser, Marja P., MD, PhD, Tijssen, Jan G.P., MD, PhD, Brunner-La Rocca, Hans-Peter, MD, PhD, Pinto, Yigal M., MD, PhD
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Analysis of Variance; Biomarkers - blood; Cardiovascular; Cause of Death; Disease Progression; Female; heart failure; Heart Failure - blood; Heart Failure - mortality; Heart Failure - physiopathology; Hospital Mortality - trends; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain - blood; NT-proBNP; Patient Admission; Patient Discharge; Peptide Fragments - blood; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Risk Assessment; risk stratification; serial measurements; Sex Factors; Survival Analysis
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2014.08.014

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