Abstract 1955: The Magnitude of Change in BNP from Admission to Discharge Predicts Outcomes in Elderly Patients Admitted with Heart Failure
Background: Recent studies demonstrate the clinical value of a lower BNP upon discharge in patients admitted with heart failure. Although these values predict mortality and re-hospitalization, lower BNPs are often not achieved in the elderly (≥75 yrs.) We sought to investigate whether the percent change in discharge BNP from admission (ΔBNP) predicts clinical outcomes in this population.
Methods: We retrospectively analyzed 337 consecutive patients (≥75yrs) admitted with a primary diagnosis of HF who had both an admission BNP and a BNP measured within 48 hrs prior to discharge. All patients were followed for 6 months and the primary endpoint included mortality and the combined endpoint of re-hospitalization and death. ΔBNP was calculated as listed below: ΔBNP (%) = (Admission BNP − Discharge BNP) × 100 Admission BNP
Results: The mean admission BNP was 1027+/−841 pg/ml. The ΔBNP increased or was < 25% in 30% of patients, 25–75% in 55.8% of patients, and >75% in 14.2% of patients. In the 6 month follow up, 48 patients died, 42 patients were re-admitted, and 79 patients reached the combined endpoint of death or re-hospitalization. Compared to patients in which the ΔBNP increased or was <25% of the admission value, patients with a ΔBNP of ≥25% demonstrated a significant decrease in the combined end point (41% vs 28%, p=0.02.) The 6 month mortality and readmission rates between patients with a ΔBNP < 50 % versus ≥ 50 % change is shown below:
Conclusion: A reduction in BNP >25% during hospitalization significantly improves the combined outcome of mortality and re-hospitalization in elderly patients admitted with HF. A ΔBNP ≥ 50 % significantly decreases the 6 month mortality in this population.