title: B-type natriuretic Peptide-guided treatment for predicting outcome in patients hospitalized in sub-intensive care unit with acute heart failure.
abstract: BACKGROUND
  Studies with natriuretic peptides have suggested that physicians do not treat heart acute failure (AHF) aggressively enough, and predischarge B-type natriuretic peptide (BNP) levels may be a useful reminder that more treatment is required. The purpose of this study was to demonstrate that variations in BNP levels during hormone-guided treatment and measured body hydration status enable the timing of the patient's discharge to be optimized.
  
  
  RESULTS
  We retrospectively evaluated 186 patients admitted for AHF. All subjects underwent serial bioelectrical impedance analysis and BNP measurement. Therapy was titrated according to BNP value to reach a BNP value of <250 pg/mL, whenever is possible. A BNP value on discharge of <250 pg/mL (obtained in 54% of the patients) predicted a 16% event rate within 6 months, whereas a value >250 pg/mL was associated with a far higher percentage (78%) of adverse events. Among the former, no significant differences in event rate were seen in relation to the time necessary to obtain a reduction in BNP values below 250 pg/mL (14 versus 18%, chi-square = 0.3, NS). Cox regression showed that a BNP cutoff value of 250 pg/mL is the most accurate predictors of events.
  
  
  CONCLUSIONS
  Our study demonstrates the usefulness of BNP in intrahospital stratification of AHF, in the decision-making process, and as a tool for "tailored therapy." Integrating this approach into the routine assessment of HF patients would allow clinicians to more accurately identify high-risk patients, who may derive increased benefit from intensive in-hospital management strategies.
authors.affiliation: Heart Failure Unit, Department of Cardiology, Ospedale Civile, S. Donà di Piave - Venice.
authors.forename: Roberto
authors.initials: R
authors.lastname: Valle
authors.forename: Nadia
authors.initials: N
authors.lastname: Aspromonte
authors.forename: Prospero
authors.initials: P
authors.lastname: Giovinazzo
authors.forename: Emanuele
authors.initials: E
authors.lastname: Carbonieri
authors.forename: Mario
authors.initials: M
authors.lastname: Chiatto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: di Tano
authors.forename: Mauro
authors.initials: M
authors.lastname: Feola
authors.forename: Massimo
authors.initials: M
authors.lastname: Milli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fontebasso
authors.forename: Sabrina
authors.initials: S
authors.lastname: Barro
authors.forename: Stefania
authors.initials: S
authors.lastname: Bardellotto
authors.forename: Loredano
authors.initials: L
authors.lastname: Milani
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010351:Patient Discharge / Q000639:trends*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D020097:Natriuretic Peptide, Brain