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07. Syncope and Bradycardia
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Heart failure – Prognostic Evaluation of the Return to Baseline NTproBNP Value at Discharge
Session:
Painel 1 - Insuficiência Cardíaca 7
Speaker:
Pedro Custodio
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Pedro Custódio; Gonçalo Lopes Da Cunha; Diogo Faustino; Laura Moreira; Sara Trevas; Tiago Pacheco; Marta Roldão; Luis Campos; Célia Henriques; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Introduction:</strong></p> <p>The natural history of chronic heart failure is associated with progressive increase in hospitalization rates, worsening of quality of life and prognosis, with an incomplete return to patient previous baseline status. The association between natriuretic peptides (NP) plasma levels at discharge for acute heart failure (AHF) and patient prognosis is well established. An in-hospital NT proBNP reduction >30% showed to be predictive of a reduced mortality. </p> <p> NP values in AHF hospitalizations have been interpreted independently from the previous patient baseline value.</p> <p> Our aim was to assess the prognostic value of the return of serum NP concentration to previous baseline value at the time of discharge, after an admission for heart failure (HF) decompensation.</p> <p> </p> <p><strong>Methods:</strong></p> <p>A retrospective study using data from patients hospitalized with AHF 2016 to 2018 in a single hospital. We considered baseline NTproBNP as the lowest value in a stable, euvolemic, outpatient in the 12 months previous to the hospital admission for HF decompensation.</p> <p> Patients that lacked NT-pro BNP values at admission and discharge day were excluded as well as patients lacking a baseline NTproBNP value before worsening of HF symptoms. Kaplan-Meier survival curves were used to evaluate mortality at 1 year.</p> <p> </p> <p><strong>Results:</strong></p> <p> A total of 107 patients were included(median age 77,91+/-9,15 years; 52.3%(n=56) male; 42,1%(n=45) heart failure with reduced ejection fraction(HFrEF); 34,5%(n=37) ischemic etiology).</p> <p> Patients were divided by groups based on in-hospital 30% NTproBNP reduction and return to the previous NTproBNP baseline level. 40,2% didn’t reach a 30% reduction in their NTproBNP level from admission to discharge nor attained their baseline NTproBNP value; 17,8% reached a 30% NTproBNP reduction from admission to discharge but didn’t reach their baseline value; 17,8% reached their baseline NTproBNP concentration without 30% NTproBNP reduction. The remaining 24,3% decreased their in-hospital NTproBNP by 30% and reached their previous baseline NTproBNP value.</p> <p> Patients discharged at baseline NTproBNP value (17,8+24,3%) had a lower mortality at 1 year follow-up (p = 0,001),independently of a 30% in-hospital NTproBNP reduction.</p> <p> In an univariable analysis, the attainment of baseline NT proBNP values at discharge(B-BNP-D) for AHF hospitalizations correlates with lower mortality in the follow-up.</p> <p> This is statistically significant in a multivariable analysis even after adjustment for age, ejection fraction, in-hospital NTproBNP reduction, serum ureia concentration at admission and serum creatinine at discharge(figure 1) .</p> <p> </p> <p> <strong>Conclusion:</strong></p> <p> In AHF hospitalizations, the evaluation of the return to baseline NTproBNP value at discharge adds prognostic value to the in-hospital NTproBNP reduction.</p>
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