title: B-type natriuretic peptide predicts 30-day readmission for heart failure but not readmission for other causes.
abstract: BACKGROUND
  B-type natriuretic peptide (BNP) is a marker for heart failure (HF) severity, but its association with hospital readmission is not well defined.
  
  
  RESULTS
  We identified all hospital discharges (n=109 875) with a primary diagnosis of HF in the Veterans Affairs Health Care System from 2006 to 2009. We examined the association between admission (n=53 585), discharge (n=24 326), and change in BNP (n=7187) and 30-day readmission for HF or other causes. Thirty-day HF readmission was associated with elevated admission BNP, elevated discharge BNP, and smaller percent change in BNP from admission to discharge. Patients with a discharge BNP ≥ 1000 ng/L had an unadjusted 30-day HF readmission rate over 3 times as high as patients whose discharge BNP was ≤ 200 ng/L (15% vs. 4.1%). BNP improved discrimination and risk classification for 30-day HF readmission when added to a base clinical model, with discharge BNP having the greatest effect (C-statistic, 0.639 to 0.664 [P<0.0001]; net reclassification improvement, 9% [P<0.0001]). In contrast, 30-day readmission for non-HF causes was not associated with BNP levels during index HF hospitalization.
  
  
  CONCLUSIONS
  In this study of over 50 000 veterans hospitalized with a primary diagnosis of HF, BNP levels measured during hospitalization were associated with 30-day HF readmission, but not readmissions for other causes. These data may help guide future study aimed at identifying the optimal timing for hospital discharge and help allocate high-intensity, HF-specific transitional care interventions to the patients most likely to benefit.
authors.affiliation: Department of Internal Medicine, Stanford University, Stanford, CA (K.M.F., M.P., P.A.H.).
authors.forename: Kelsey M
authors.initials: KM
authors.lastname: Flint
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (L.A.A.) Colorado Cardiovascular Outcomes Research Consortium, Denver, CO (L.A.A.).
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: Department of Internal Medicine, Stanford University, Stanford, CA (K.M.F., M.P., P.A.H.) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (M.P., P.A.H.).
authors.forename: Michael
authors.initials: M
authors.lastname: Pham
authors.affiliation: Department of Internal Medicine, Stanford University, Stanford, CA (K.M.F., M.P., P.A.H.) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (M.P., P.A.H.).
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: heart failure; natriuretic peptides; patient readmission; prognosis