Fall in readmission rate for heart failure after implementation of B-type natriuretic peptide testing for discharge decision: a retrospective study.
BACKGROUND
B-type natriuretic peptide is the most powerful predictor of long term prognosis in patients hospitalised with heart failure. On an outsetting basis, a decrease in B-type natriuretic peptide levels is associated to a decrease in event rate for outpatients managed using the neuro-hormone levels as the target in heart failure therapy. We have retrospectively checked whether the addition of pre-discharge B-type natriuretic peptide levels to a clinical-instrumental decisional score for discharge decision in patients admitted for heart failure reduced readmission rate for heart failure and related cost.


METHODS
We studied two series of consecutive patients admitted to the Heart Failure Unit due to acute heart failure as a main diagnosis. One-hundred and forty-nine patients discharged on the basis of the sole clinical acumen were compared to one hundred and sixty-six subjects discharged adding B-type natriuretic peptide levels to the decisional score.


RESULTS
During a six-month follow-up period, there were 52 readmissions (35%) among the clinical group (n=149) compared with 38 (23%) readmissions in the B-type natriuretic peptide group (n=166) (chi(2)=5.5; P=0.02). Survival did not differ between groups (87%). Changes in B-type natriuretic peptide values were correlated to clinical events: a B-type natriuretic peptide value on discharge of < or =250 pg/ml or a reduction of > or =30% in B-type natriuretic peptide values predicted a 23% event rate (death, plus readmission for heart failure), whereas a far higher percentage (71%) were observed in the remaining patients (chi(2)=32.7; P=0.001). Likewise, the overall costs of care were lower (-7%) in the B-type natriuretic peptide group: 2.781+/-923 vs 2.978+/-1.057 euros per patient respectively.


CONCLUSIONS
our study suggest that the addition of pre-discharge B-type natriuretic peptide levels to a clinical-instrumental decisional score for discharge decision in patients admitted for heart failure may contribute to reduce the number of readmissions and related cost.
Valle
Roberto
R
Heart Failure Unit, Department of Cardiology, Ospedale Civile, San Donà di Piave, Italy. robertovalle@libero.it
Aspromonte
Nadia
N
Carbonieri
Emanuele
E
D'Eri
Alessandra
A
Feola
Mauro
M
Giovinazzo
Prospero
P
Noventa
Federica
F
Prevaldi
Carolina
C
Barro
Sabrina
S
Milani
Loredano
L
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003657:Decision Making; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D020097:Natriuretic Peptide, Brain / Q000032:analysis*; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data*; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis