Abstract 12549: Early Post-Discharge Changes in NT-ProBNP Levels as Risk Stratification After Heart Failure Hospitalization
Objective. To assess the prognostic utility of early post-discharge changes in NT-proBNP after acute heart failure (AHF) admission.
Methods. Patients analyzed were included in a previously published study evaluating the effect of NT-proBNP guided therapy of heart failure, the PRIMA-study. NT-proBNP levels were assessed at discharge and at 1 month follow-up. Patients were divided into 4 groups based on NT-proBNP levels at discharge and at 1 month follow-up: i) NT-proBNP level at discharge below the median of 3,000 pg/ml and either a decrease or an increase up to 30% at 1 month(n=93), ii) level below the median at discharge and an increase more than 30% at 1 month (n=63), iii) level above the median at discharge and a decrease more than 30% at 1 month (n=46), and iv) level above the median at discharge and a either an increase, or a decrease less than 30% at 1 month
Results. Patients in group 1 and 3 had lower mortality and lower HF-readmission rates compared to group 2 and 4 (mortality at 180 days i=1%, ii=11%, iii=9% and iv=19%, p = 0.001 (figure 1.) and 180-day HF-readmission rate: i=11%, ii=30%, iii=11% and iv=40%, p <0.001). In multivariate analysis, change in NT-proBNP levels after discharge remained an important prognostic risk factor.
Conclusion. NT-proBNP levels measured one month after discharge for AHF help to evaluate risk: a moderate increase in patients discharged with NT-proBNP below 3,000 pg/ml is not associated with increased risk. In contrast, in subjects discharged with NT-proBNP above 3,000 pg/ml, a level that is not sufficiently lowered at 1 month portends worse outcome. Therefore, assessment of NT-proBNP levels at one month compared to discharge levels from an AHF admission is helpful in identifying heart failure patients at highest risk and adds to the prognostic value of NT-proBNP levels at discharge.
- © 2011 by American Heart Association, Inc.