title: The potential role of natriuretic peptide-guided management for patients hospitalized for heart failure.
abstract: There are >1 million hospitalizations for heart failure (HF) in the United States annually. After discharge, 25% of these patients are rehospitalized within 30 days, and 30% are dead within 1 year. To date, all trials in patients with acute HF (AHF) have failed to improve post-discharge outcomes. There remains a need for an effective objective risk stratification strategy that is capable of reliably identifying patients at heightened risk for readmission and informing discharge decision making. Natriuretic peptide (NP) levels during and after AHF hospitalization can provide valuable information regarding congestion status and chronic remodeling stress. The lack of sensitivity and inter-rater reliability of physical examination, and failure to achieve dry weight in many patients before discharge, renders the use of NP to guide therapy to prevent readmission an attractive option. NP levels can be used across the spectrum of AHF care settings, ranging from the emergency department and inpatient stay to post-discharge follow-up and chronic management. This review summarizes available data and provides an expert opinion on the potential role of NPs to reduce HF readmissions.
authors.affiliation: Division of Cardiology, Department of Medicine, University of California San Diego and San Diego Veterans Administration Medical Center, San Diego, California.
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.affiliation: Division of Cardiology, Department of Medicine, University of California San Diego and San Diego Veterans Administration Medical Center, San Diego, California.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xue
authors.affiliation: Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Greene
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.affiliation: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York.
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.affiliation: Department of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Christopher
authors.initials: C
authors.lastname: DeFilippi
authors.affiliation: Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, New York. Electronic address: javed.butler@stonybrookmedicine.edu.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
mesh_terms: D015415:Biomarkers / Q000097:blood; D019468:Disease Management; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D045265:Natriuretic Peptides / Q000097:blood*
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides
keywords: Heart failure; hospitalization; natriuretic peptides; readmission