Acute Changes in N‐Terminal Probrain Natriuretic Peptide During Hospitalization and the Risk of Readmission and Mortality in Patients with Congestive Heart Failure

1Johns Hopkins University School of Medicine, Baltimore, MD
2Johns Hopkins University School of Medicine, Baltimore, MD
3Johns Hopkins University School of Medicine, Baltimore, MD
4Johns Hopkins University School of Medicine, Baltimore, MD
5Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
6Johns Hopkins University School of Medicine, Baltimore, MD
7Johns Hopkins University School of Medicine, Baltimore, MD

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 95

Background:

Congestive heart failure (CHF) is characterized by multiple hospital readmissions and increased risk of death. Some studies suggest using serial changes in N‐terminal probrain natriuretic peptide (NT‐proBNP) as a predictor of adverse events in CHF patients, but these have been limited. Our study assessed acute change in NT‐proBNP and its association with 1‐year mortality and readmission.

Methods:

Data were analyzed from a cohort of 240 consecutive patients ages 25 and older who were admitted to an urban tertiary‐care hospital from June 2006 to April 2007 with a primary diagnosis of heart failure and who received intravenous furosemide. Creatinine and NT‐proBNP levels were measured on admission and at discharge of the first admission. We collected patient demographics, comorbidities, and hospital length of stay. Patients were prospectively grouped into 2 categories based on acute changes in NT‐proBNP during the first admission: a decline ≥ 50% or < 50% in discharge NT‐proBNP level compared with that on admission. We defined outcome as readmission or death within 1 year of the first hospital discharge. Kaplan‐Meier survival curves were generated, and multivariable Cox regressions were performed to adjust for potential confounders.

Results:

After excluding patients who died during the initial admission (n = 3) or those with incomplete records (n = 20), 45% (n = 97), and 55% (n = 120) had a decline ≥ 50% or < 50% in discharge NT‐proBNP level, respectively. Our study population was 50% male and 67% nonwhite, with a mean age of 63 ± 14 years, median creatinine of 1.2 mg/dL (IQR: 1.0, 1.7 mg/dL), median admission NT‐proBNP level of 5913 pg/mL (1831, 10,989 pg/mL). median ejection fraction of 30% (15%, 55%), and median duration of hospital stay of 5 days (3, 8 days). Comorbid medical conditions included hypertension (70%), diabetes (48%), coronary artery disease (43%), atrial arrhythmia (30%), COPD (23%), stroke (14%), and peripheral vascular disease (13%). Forty‐eight patients died, and 86 were readmitted at least once. Rates of readmission/death were 2.2 and 3.2 per 1000 patient days in the ≥ 50% and < 50% groups, respectively (P = 0.035). After adjustment for age, sex, race, and admission creatinine and NT‐proBNP levels, the hazard of readmission/death was 57% higher for those with a < 50% decline in NT‐proBNP level (HR 1.57, 95% Cl 1.08, 2.28; P = 0.02). Additional adjustments for comorbidity, initial hospitalization length of stay, and ejection fraction did not significantly change this relationship.

Conclusions:

Improvement in NT‐proBNP < 50% during an acute hospitalization for congestive heart failure is associated with a higher hazard of read mission/death, independent of age, sex, race, creatinine level, admission NT‐proBNP level, comorbidities, ejection fraction, and length of slay. These individuals may benefit from more intensive medical treatment, monitoring, and follow‐up to prevent subsequent readmissions or death.

Author Disclosure:

H. Michtalik, none; D. Brotman, Siemens Healthcare Diagnostics, Research Support; H. Yeh, none; C. Campbell, none; W. Clarke, none; H. Park, none; N. Haq, none.

To cite this abstract:

Michtalik H, Yeh H, Campbell C, Haq N, Park H, Clarke W, Brotman D. Acute Changes in N‐Terminal Probrain Natriuretic Peptide During Hospitalization and the Risk of Readmission and Mortality in Patients with Congestive Heart Failure. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 95. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/acute-changes-in-nterminal-probrain-natriuretic-peptide-during-hospitalization-and-the-risk-of-readmission-and-mortality-in-patients-with-congestive-heart-failure/. Accessed September 17, 2019.

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