Abstract 13081: Predicting Non-response to NT-proBNP Guided Heart Failure Management Using the PROTECT Risk Score
Background: N-terminal pro-B type natriuretic peptide (NT-proBNP) is strongly predictive of heart failure (HF) prognosis. Some patients respond to aggressive HF management with a significant reduction in NT-proBNP while others do not. This NT-proBNP “non-responder” profile is associated with higher risk as well as increased utilization of healthcare resources. We sought to predict “non-response” among ambulatory patients with HF due to left ventricular systolic dysfunction (LVSD).
Methods: 151 HF patients with LVSD were studied in the ProBNP Outpatient Tailored Chronic HF Therapy (PROTECT) Trial. Variables at first office visit independently predictive of non-response (defined as NT-proBNP >1000 pg/mL following a mean of 10 months of study participation) were assembled in a risk score.
Results: Four factors comprised the final PROTECT Non-responder Risk Score: baseline NT-proBNP value (3 points for NT-proBNP > 5000 pg/mL, 2 points for 1000-5000 pg/mL and 0 point for < 1000 pg/mL), NYHA class 3 or 4 (1 point), heart rate <60 BPM (1 point) and prevalent atrial fibrillation (1 point). Receiver operating characteristic curve analysis of the score's ability to predict non-response produced an area under the curve of 0.82 (p < 0.001). A score ≥ 3 points had a sensitivity of 79%, specificity of 68%, positive predictive value of 79% and negative predictive value of 68% for non-response (figure). Of those with a score ≥ 3, 79% ultimately were non-responders; among those with a score below 3, the non-response rate was 32%. Cumulative hazard for cardiovascular events for patients with a PROTECT Risk Score ≥ 3 was dramatically higher than patients with a Score < 3 (p < 0.001).
Conclusion: The PROTECT Non-response Risk Score is a novel risk stratification tool for identifying patients likely to fail NT-proBNP guided HF therapy, and with imminent risk for complications. Such patients may merit consideration for timely institution of more aggressive or invasive HF care.
- © 2011 by American Heart Association, Inc.