Serial NT-proBNP monitoring and outcomes in outpatients with decompensation of heart failure.
BACKGROUND
NT-proBNP is useful for heart failure (HF) diagnosis and prognosis. We examined the value of serial NT-proBNP monitoring to predict outcomes in decompensated HF patients attending a structured HF clinic.


METHODS
Patients with decompensation of established optimally treated HF, not requiring emergency hospital admission, were enrolled in the study. Patients received intensive follow-up weekly during 4 weeks and at 3 months in specialist HF clinics. Serial NT-proBNP concentrations were measured at each visit. Primary endpoint was cardiovascular death and hospital admission for HF at 3 months.


RESULTS
Fifty-nine patients were enrolled (60+/-14 years, LVEF 27+/-9%) and 39% had a primary endpoint during follow-up. Baseline NT-proBNP concentration (in ng/L) was 7050+/-6620, and did not differ significantly in patients with and without events (p=0.22). Patients without events showed marked NT-proBNP reduction at week-1 (30% reduction), week-2 (36% reduction), week-3 (34% reduction) and week-4 (37% reduction). By contrast, patients with events showed no significant NT-proBNP reduction during follow-up. Using a general linear model, the relative NT-proBNP reductions (%) at weeks 1-4 were predictors of adverse events (p=0.004, p<0.001, p=0.001 and p=0.03, respectively). In a stepwise multiple Cox regression analysis, NT-proBNP relative reduction (in %) at week 2 was a strong predictor of no events during follow-up (OR 0.79, 95% CI 0.70-0.88, p<0.001).


CONCLUSIONS
Serial NT-proBNP monitoring in decompensated HF patients seen in a structured in-hospital HF clinic predicts cardiovascular events during follow-up. NT-proBNP may be useful in an outpatient basis to identify patients at high risk needing more aggressive therapy.
Bayes-Genis
Antoni
A
Hospital Santa Creu i Sant Pau, Barcelona, Spain. abayesgenis@santpau.es
Pascual-Figal
Domingo
D
Fabregat
Jordi
J
Domingo
Maite
M
Planas
Francesc
F
Casas
Teresa
T
Ordoñez-Llanos
Jordi
J
Valdes
Mariano
M
Cinca
Juan
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010044:Outpatient Clinics, Hospital; D010343:Patient Admission / Q000706:statistics & numerical data*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D004232:Diuretics; D006454:Hemoglobins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain