title: Predictive value for death and rehospitalization of 30-day postdischarge B-type natriuretic peptide (BNP) in elderly patients with heart failure. Sub-analysis of Italian RED Study.
abstract: BACKGROUND
  Our aim was to determine if, in elderly heart failure (eHF) patients, serial B-type natriuretic peptide (BNP) assessments obtained during follow-up after hospital discharge could have prognostic utility for death and rehospitalizations. In eHF patients, BNP assessment at hospital discharge has been demonstrated to have a high prognostic value; however, its predictive role for future cardiovascular events in eHF patients, when assessed in the period after discharge, both for the correct timing and cut-off levels, has not been completely elucidated.
  
  
  METHODS
  This study is a monocentric subanalysis of the Italian RED (Rapid Emergency Department) study. We studied 180 consecutive patients admitted for acute HF through serial BNP assessments: at hospital arrival; at discharge; and at 30, 90, and 180 days follow-up outpatient visit.
  
  
  RESULTS
  Both a BNP >400 pg/mL at 30 days after discharge and the percentage variation of BNP from discharge to 30 days (Δ%BNP), compared with a BNP at discharge >400 pg/mL, showed a higher area under the curve (AUC) and odds ratio (OR) in predicting events [AUC=0.842, p<0.0001; OR 7.9 (3.3-19.0), p<0.001 for 30 days BNP and AUC=0.851, p<0.0001; OR 9.5 (4.065-22.572), p<0.0001 for Δ%BNP compared with AUC=0.638, p<0.002; OR 2.4 (1.1-5.3), p=0.032 for BNP at discharge].
  
  
  CONCLUSIONS
  In patients at a high risk for future events, BNP levels assessed 30 days after hospital discharge in the absence of signs and symptoms could be predictive of subsequent hospitalization and death. These patients should be considered for closer monitoring and treatment adjustment.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.forename: Rossella
authors.initials: R
authors.lastname: Marino
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zampini
authors.forename: Laura
authors.initials: L
authors.lastname: Magrini
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferri
authors.forename: Kevin
authors.initials: K
authors.lastname: Shah
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000032:analysis*; D010351:Patient Discharge; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D020097:Natriuretic Peptide, Brain