BNP-guided therapy optimizes the timing of discharge and the medium term risk stratification in patients admitted for congestive heart failure

https://doi.org/10.4081/monaldi.2007.448

Authors

  • Roberto Valle | robertovalle@libero.it Centro per lo scompenso cardiaco. Unità operativa complessa di Cardiologia, Ospedale civile, San Donà di Piave, Italy.
  • Nadia Aspromonte Unità per lo scompenso cardiaco. Unità operativa complessa di Cardiologia, Ospedale Santo Spirito, Roma, Italy.
  • Emanuele Carbonieri Centro per lo scompenso cardiaco. Unità operativa autonoma di Cardiologia, Ospedale civile, San Bonifacio, Italy.
  • Giorgio De Michele Centro per lo scompenso cardiaco. Unità operativa complessa di Cardiologia, Ospedale civile, San Donà di Piave, Italy.
  • Giuseppe Di Tano Unità operativa complessa, Azienda Ospedaliera Papardo, Messina, Italy.
  • Prospero Giovinazzo Centro per lo scompenso cardiaco. Unità operativa complessa di Cardiologia, Ospedale civile, San Donà di Piave, Italy.
  • Roberta Cioè Centro per lo scompenso cardiaco. Unità operativa complessa di Cardiologia, Ospedale civile, San Donà di Piave, Italy.
  • Tiziana Di Giacomo Centro per lo scompenso cardiaco. Unità operativa complessa di Cardiologia, Ospedale civile, San Donà di Piave, Italy.
  • Loredano Milani Centro per lo scompenso cardiaco. Unità operativa complessa di Cardiologia, Ospedale civile, San Donà di Piave, Italy.
  • Federica Noventa Centro per lo scompenso cardiaco. Unità operativa complessa di Cardiologia, Ospedale civile, San Donà di Piave, Italy.
  • Mario Chiatto Unità operativa complessa di Cardiologia, Azienda Ospedaliera di Cosenza, Italy.

Abstract

most important cause of hospitalizations and is associated with high cost. Despite a consistent body of data demonstrating the benefits of drug therapy in HF, persistently high rates of readmission, especially within six months of discharge, continue to be documented. Neurohormonal activation characterizes the disease; plasma brain natriuretic peptide (BNP), is correlated with the severity of left ventricular dysfunction and relates to outcome. Objective: The aim of the study was to evaluate if plasma levels of BNP would provide an index to guide drug treatment and to predict medium-term prognosis in HF patients (pts) after hospital discharge. Methods and Results: We evaluated 200 consecutive pts (age 77±10 (35–96) years, 49% male versus 51% female) hospitalized for HF (DRG 127). Standard echocardiography was performed and left ventricular systolic/diastolic function was assessed; plasma BNP levels were measured with a rapid point-of-care assay (Triage BNP Test, Biosite Inc, San Diego, CA) on days 1 and after initial treatment. Using a cut-off of 240 pg/ml and/or changes in plasma BNP (days 2-3 after admission), 2 groups were identified: the low BNP group-responders (n= 68, BNP 30% reduction) and the high BNP group-non responders (n = 132, BNP >= 240 pg/ml and/or < 30% reduction). The high BNP group showed a different pattern of clinical variables according to the severity of the disease New York Heart Association (NYHA) functional class, left ventricular ejection fraction, ischemic etiology and age. A sustained elevation of plasma BNP (> 240 pg/mL) indicated the presence of a clinical unstable condition requiring further intervention whereas pts with low BNP values were discharged after 24 hours. During a mean follow-up period of 3 months, there were 62 cardiac events, including 15 cardiac deaths, 22 readmissions for worsening heart failure and 25 clinical decompensation requiring diuretic treatment. The incidence of clinical events was significantly greater in pts with higher levels of BNP (admission and discharge) than in those with lower levels (42% vs. 10%) and plasma values > 500 pg/ml identified a subgroup at high risk of death. Conclusions: The influence of BNP in the clinical course and prognosis of patients hospitalized for HF has not been studied. After initial treatment pts need to be risk stratified by means of the BNP test, to guide further management and to identify subjects with poor prognosis. An aggressive therapeutic and follow-up strategy may be justified for pts with high BNP levels and/or no changes after hospital admission for worsening HF. The changes in plasma BNP level at discharge were significantly related to cardiac events.

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Published
2016-02-01
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Original Articles
Keywords:
brain natriuretic peptide, heart failure, prognosis
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How to Cite
Valle, Roberto, Nadia Aspromonte, Emanuele Carbonieri, Giorgio De Michele, Giuseppe Di Tano, Prospero Giovinazzo, Roberta Cioè, Tiziana Di Giacomo, Loredano Milani, Federica Noventa, and Mario Chiatto. 2016. “BNP-Guided Therapy Optimizes the Timing of Discharge and the Medium Term Risk Stratification in Patients Admitted for Congestive Heart Failure”. Monaldi Archives for Chest Disease 68 (3). https://doi.org/10.4081/monaldi.2007.448.

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