SPC365

Early post-discharge NTproBNP levels as a marker of prognosis in heart failure patients

Session: Sessão de Posters 21 - Insuficiência cardíaca aguda
Speaker: Mariana Passos

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 11. Acute Heart Failure
Subtheme: 11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: Mariana Passos; Filipa Gerardo; Joana Lima Lopes; Carolina Mateus; Inês Miranda; Mara Sarmento; Inês Fialho; Ana Oliveira Soares; David Roque

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Introduction:</span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif"> N-terminal pro-brain natriuretic peptide (NTproBNP) is a commonly used biomarker for diagnosing heart failure (HF) and its decompensation. Current HF guidelines advocated for a follow-up visit within 14 days post-hospital discharge to assess HF signs, optimize treatment, and prevent decompensation. The prognostic significance of NTproBNP up to 14 days after discharge is not established.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Objective:</span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif"> To assess the prognostic value of NTproBNP levels early post-discharge in patients with HF.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Methods:</span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif"> We conducted a single-center study on 284 consecutive patients who underwent an early post discharge appointment (EPDA) between March 2021 and September 2023. Patients without NTproBNP levels assessment both at discharge and at EPDA were excluded. The primary endpoint was a composite of HF-related readmissions and all-cause death at 90 days.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Results:</span></span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black"> A total of 121 patients (median age 68 [IQR57-76] years, 34.2% female) were suitable for analysis. The median time to EPDA was 13 [IQR 11-17] days after discharge. The median NTproBNP levels at discharge were 1893 [IQR 925-3930] pg/ml and at EPDA were 2580 [IQR 1046-5601]pg/ml. The median decrease during hospitalization was 59.9 [IQR 29.4-80.5]% and the increased after discharge was 26.9 [IQR -12.8-116.3]%. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">The primary endpoint occurred in 23.7% (n=27) patients. Both NTproBNP levels at EPDA (2140 vs 4008pg/ml) and its increase (13.9% vs 85.5%) were significantly higher in patients with the primary endpoint (p=0.008 and p=0.002, respectively). No significant differences were observed in the median NTproBNP variation during hospitalization or NTproBNP discharge levels (p= 0.8 and p=0.378, respectively). Logistic regression analysis revealed that only NTproBNP variation after discharge remained independently associated with the primary outcome, after adjusting for estimated </span></span><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">glomerular filtration rate (eGFR) (OR 1.4; 95% CI 1.01-2.16; p=0.043), while NTproBNP absolute levels at EPDA showed no significant association (OR 1; 95% CI 1.0-1.0; p=0.2). Receiving operator characteristics curve analysis of NTproBNP variation adjusted for both NTproBNP at EPDA and eGFR (AUC 0.775; 95% CI 0.67-0.88; p=0.0001) yielded a better prediction score than its variation alone (AUC 0.716; 95% 0.001; p=0.001)</span></span></span><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black"> (Fig.1).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Conclusion:</span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif"> <span style="color:black">NTproBNP levels, mainly its variation, measured around 2 weeks after discharge following an acute HF episode, are valuable prognostic indicators for predicting HF-related readmissions and all-cause death at 90 days. This allows for the identification of high-risk patients who should be reassessed earlier.</span></span></span></span></p>