title: Risk stratification with the use of serial N-terminal pro-B-type natriuretic peptide measurements during admission and early after discharge in heart failure patients: post hoc analysis of the PRIMA study.
abstract: OBJECTIVE
  The aim of this work was to assess the prognostic value of absolute N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration in combination with changes during admission because of acute heart failure (AHF) and early after hospital discharge.
  
  
  BACKGROUND
  In AHF, readmission and mortality rates are high. Identifying those at highest risk for events early after hospital discharge might help to select patients in need of intensive outpatient monitoring.
  
  
  RESULTS
  We evaluated the prognostic value of NT-proBNP concentration on admission, at discharge, 1 month after hospital discharge and change over time in 309 patients included in the PRIMA (Can PRo-brain-natriuretic peptide guided therapy of chronic heart failure IMprove heart fAilure morbidity and mortality?) study. Primary outcome measures were mortality and the combined end point of heart failure (HF) readmission or mortality. In a multivariate Cox regression analysis, change in NT-proBNP concentration during admission, change from discharge to 1 month after discharge, and the absolute NT-proBNP concentration at 1 month after discharge were of independent prognostic value for both end points (hazard ratios for HF readmission or mortality: 1.71, 95% confidence interval [CI] 1.13-2.60, Wald 6.4 [P = .011] versus 2.71, 95% CI 1.76-4.17, Wald 20.5 [P < .001] versus 1.81, 95% CI 1.13-2.89, Wald 6.1 [P = .014], respectively.
  
  
  CONCLUSIONS
  Knowledge of change in NT-proBNP concentration during admission because of AHF in combination with change early after discharge and the absolute NT-proBNP concentration at 1 month after discharge allows accurate risk stratification.
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands. Electronic address: leurlings@gmail.com.
authors.forename: Luc W
authors.initials: LW
authors.lastname: Eurlings
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sanders-van Wijk
authors.affiliation: Department of Cardiology, Orbis Medical Center, Sittard, The Netherlands.
authors.forename: Dave J W
authors.initials: DJ
authors.lastname: van Kraaij
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Roland
authors.initials: R
authors.lastname: van Kimmenade
authors.affiliation: Department of Cardiology, Viecuri Medical Center, Venlo, The Netherlands.
authors.forename: Joan G
authors.initials: JG
authors.lastname: Meeder
authors.affiliation: Department of Cardiology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.affiliation: Department of Clinical Chemistry, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Marja P
authors.initials: MP
authors.lastname: van Dieijen-Visser
authors.affiliation: Department of Cardiology, Heart Failure Research Center, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
authors.affiliation: Department of Cardiology, Heart Failure Research Center, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Yigal M
authors.initials: YM
authors.lastname: Pinto
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality* / Q000503:physiopathology; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission; D010351:Patient Discharge; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: NT-proBNP; heart failure; risk stratification; serial measurements