title: Usefulness and predictive value of circulating NT-proBNP levels to stratify patients for referral and priority treatment in a specialized outpatient heart failure center.
abstract: BACKGROUND
  Serum natriuretic peptide levels are useful diagnostic and prognostic markers in patients with acute decompensated heart failure, but have been little used to stratify urgency of treatment in the outpatient situation.
  
  
  OBJECTIVE
  To examine the use of natriuretic peptide to guide priority of patient referral to a heart failure center.
  
  
  METHODS
  We analyzed data from 70 consecutive patients with chronic heart failure (NYHA class 2-4) referred for first evaluation in a specialized outpatient heart failure center. Serum NT-proBNP was measured at the initial patient visit. We examined correlates and predictive value of mid- and upper tertile NT-proBNP for mortality in comparison with other known prognostic indicators using univariate and multivariate logistic regression analysis.
  
  
  RESULTS
  Mortality at 6 months was 26.0% in patients with upper tertile (> 1958 pg/ml) NT-proBNP, 8.7% in the middle tertile group and 0% in the lowest tertile (P=0.017). Patients with upper tertile serum NT-proBNP levels (group 3) had lower left ventricular ejection fraction, were more often in atrial fibrillation (P=0.04) and more often had renal failure (P=0.03). Age-adjusted logistic regression analysis identified upper tertile serum NT-proBNP level as the strongest independent predictor of 6 month mortality with a sixfold risk of early death (adjusted odds ratio 6.08, 95% confidence interval 1.58-47.13, P=0.04). NT-proBNP was a more powerful predictor of prognosis than ejection fraction and other traditional outcome markers.
  
  
  CONCLUSIONS
  In heart failure patients referred to an outpatient specialized heart failure center, an upper tertile NT-proBNP level identified patients at high risk for mortality. A single high > 550 pg/ml NT-proBNP measurement appears to be useful for selecting patients for care in a heart failure center, and a level > 2000 pg/ml for assigning patients to high priority management.
authors.affiliation: Heart Failure Center, Department of Cardiovascular Medicine, Lady Davis Carmel and Lin Medical Centers, Haifa, Israel.
authors.forename: Offer
authors.initials: O
authors.lastname: Amir
authors.forename: Hagar
authors.initials: H
authors.lastname: Paz
authors.forename: Ronny
authors.initials: R
authors.lastname: Ammar
authors.forename: Nisan
authors.initials: N
authors.lastname: Yaniv
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Schliamser
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
mesh_terms: D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007124:Immunoenzyme Techniques; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010044:Outpatient Clinics, Hospital; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011498:Protein Precursors; D012017:Referral and Consultation; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain