B-type natriuretic peptide level and postdischarge thrombotic events in older patients hospitalized with heart failure: insights from the Acute Decompensated Heart Failure National Registry.
BACKGROUND
Patients hospitalized with heart failure (HF) have elevated B-type natriuretic peptide (BNP) levels and increased risk for thromboembolic events. Associations between BNP level and thromboembolic events in patients with HF without atrial fibrillation (AF) are not well studied.


METHODS
We linked data from the ADHERE registry for 2003 through 2006 with Medicare claims to identify patients ≥65 years who were hospitalized with HF, did not have AF, and did not receive warfarin at discharge. We estimated rates of all-cause mortality, thromboembolic events, myocardial infarction (MI), and stroke using Kaplan-Meier methods and the cumulative incidence function. We used Cox models to assess associations between log BNP level and each outcome after adjustment for potential confounders.


RESULTS
The study population included 11,679 patients from 146 sites. Patients in the highest quartile of BNP level were older and more often male and African American. They had higher rates of coronary artery disease, renal insufficiency, and peripheral vascular disease and lower rates of diabetes mellitus and chronic obstructive pulmonary disease. After multivariable adjustment, each 30% increase in BNP level was associated with increased risks of death (hazard ratio 1.07, 95% CI 1.05-1.08) and MI (1.07, 1.04-1.10) but not thromboembolism or stroke.


CONCLUSIONS
Higher BNP level upon admission with HF among older patients without AF was associated with increased risks of MI and mortality; however, higher BNP level was not associated with subsequent thromboembolism or stroke.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA. rkociol@tuftsmedicalcenter.org
Robb D
RD
Kociol
Melissa A
MA
Greiner
Bradley G
BG
Hammill
Zubin J
ZJ
Eapen
Gregg C
GC
Fonarow
Winslow
W
Klaskala
Roger M
RM
Mills
Lesley H
LH
Curtis
Adrian F
AF
Hernandez
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology; D015897:Comorbidity; D003625:Data Collection; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012042:Registries; D020521:Stroke / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology
D020097:Natriuretic Peptide, Brain