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NTproBNP in acute heart failure: which values to rely on to estimate long-term prognosis?
Session:
Posters 4 - Écran 10 - Insuficiência Cardíaca
Speaker:
Rafael Santos
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.3 Chronic Heart Failure – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Rafael Santos; João Pedro Ribeiro Agostinho; Inês Gonçalves; Joana Rigueira; Inês Aguiar Ricardo; Afonso Nunes Ferreira; Tiago Graça Rodrigues; Nelson P. Cunha; Maria Mónica Mendes Pedro; Fátima Veiga; Fausto José Pinto; Dulce Brito
Abstract
<p><strong>Background: </strong>Hospitalizations remain a main cause of morbidity and mortality in heart failure (HF) patients (pts), and readmission rate is still unacceptably high. NTproBNP is widely used as a tool in establishing the diagnosis of HF and as a marker of decompensation. However its efficacy in predicting readmissions is not well established.</p> <p><strong>Aim:</strong> To evaluate the efficacy of NTproBNP in predicting all-cause hospital readmissions during the first year after discharge (index-hospitalization for acute HF).</p> <p><strong>Methods</strong>: Retrospective study with prospective data registry of consecutive pts discharged after hospitalization for acute HF. All pts were submitted to clinical, laboratorial, electrocardiographic and echocardiographic evaluations, including NTproBNP on admission and at discharge. Multivariate Cox regression and Kaplan-Meier survival analysis were used to evaluate NTproBNP utility as a predictor of readmissions.</p> <p> </p> <p><strong>Results</strong>: One hundred and fifty six pts were included (mean age: 68.1 ± 12.4 years, 60.1% males). The mean left ventricular ejection fraction (LVEF) was 36.4 ± 15.9% (LVEF < 40% in 60.3%). Patients were discharged in NYHA functional class I (44.8%), in class II (51.9%), and in class III (3.2%). During a mean follow-up time of 11.1 ± 2.6 months, the readmission rate was 46.2%, and the mortality rate was 10.3%.</p> <p>The median NTproBNP values were 4222 (IQ: 1981-9715) pg/mL on admission, and 1717 (IQ: 858-4249) pg/mL at discharge. In 92.5% of pts there was a decrease of NTproBNP during hospitalization, and the average descent rate was 48.1 ± 31.9%.</p> <p>The presence of preserved LVEF (p = 0.011) and worse functional class at discharge (p = 0.005) were associated with readmissions during follow up. NTproBNP at discharge (p = 0.036), particularly if values > 4250pg/mL (4<sup>th</sup> quartile) were also linked to higher probability of readmission (p = 0.024).</p> <p>By multivariate analysis (age-adjusted) discharge NTproBNP > 4250pg/mL was established as an independent factor to predict readmissions (HR = 2.6, CI = 1.2-6.0, p = 0.022).</p> <p>There was no association between admission NTproBNP or the magnitude of decrease during hospitalization and the rate of readmission during follow up (p = NS). Additionally, an increase of NTproBNP during hospitalization did not predict readmissions as well (p = NS).</p> <p><strong>Conclusions</strong>: NTproBNP at discharge is an important biomarker to predict one-year hospital readmissions. However, contrary to expectations, the absolute value of NTproBNP at discharge, mainly in the presence of higher biomarker levels, seems to be more important than its variation (decrease or increase) during hospitalization for acute HF.</p>
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