Page 104 - Biomarkers for risk stratification and guidance in heart failure
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Serial NT-proBNP measurements during and early after HF admission.
INTRODUCTION
Acute heart failure (HF) is not only associated with a high in-hospital mortality rate,1 but short- and long-term prognosis after hospital discharge also remains poor, with high mortality and readmission rates.2,3 Therefore, post-discharge risk stratification is important because it may help to identify those patients in need of intensive outpatient monitoring and treatment. Unfortunately, even for trained clinicians it can be quite challenging to accurately stratify risk in those who have recently been admitted because of acute HF. During the last decade, B-type natriuretic peptide (BNP) and its cleavage equivalent N-terminal pro- BNP (NT-proBNP) have proved to be powerful prognostic markers in both acute and chronic HF. In acute HF, both pre-discharge (NT-pro)BNP concentration and decrease in NT-proBNP during hospital admission are related to outcome after hospital discharge.4,5 Also in chronic HF, not only does a single measurement of natriuretic peptides reflect risk, but variation in natriuretic peptides also adds to prognostic assessment.6
However, the prognostic value of change in NT-proBNP concentration 1 month 5 after admission because of acute HF has not yet been evaluated. Furthermore,
the incremental value of serial NT-proBNP measurements during admission and
early after hospital discharge has not yet been assessed. Therefore, we sought to
identify which NT-proBNP parameters during admission and early after discharge (ie, absolute NT-proBNP concentration at admission, discharge, 1 month after hospital discharge, change in NT-proBNP during admission \[‘‘inpatient change’’\], and change in NT-proBNP concentration between discharge and 1 month after discharge \[‘‘early outpatient change’’\]) were of independent prognostic importance. Finally, because biologic variation of NT-proBNP in HF has been reported to be high in chronic HF,7 one might conclude that only large early outpatient changes in NT-proBNP have prognostic impact. Therefore, we also assessed the prognostic impact of relatively small early outpatient changes in NT- proBNP (ie, changes up to 30%).
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