title: Clinical profile and prognostic significance of natriuretic peptide trajectory following hospitalization for worsening chronic heart failure: findings from the ASTRONAUT trial.
abstract: OBJECTIVE
  The purpose of this study was to determine the prognostic significance and associated clinical profile of early post-discharge N-terminal pro-B-type natriuretic peptide (NT-proBNP) trajectory among patients hospitalized for worsening chronic heart failure (HHF).
  
  
  RESULTS
  This post-hoc analysis of the Aliskiren Trial in Acute Heart Failure Outcomes (ASTRONAUT) included 1351 HHF patients with ejection fraction (EF) ≤40%, elevated B-type natriuretic peptide ≥400 pg/mL or NT-proBNP ≥1600 pg/mL at admission, and available NT-proBNP measurements (from a central core laboratory) at baseline (median 5 days after admission) and 1-month follow-up. The co-primary endpoints were all-cause mortality and cardiovascular mortality or HHF within 12 months. Median follow-up was 11.3 months. Patients with decreasing post-discharge NT-proBNP trajectory tended to be younger and have non-ischaemic HF aetiology. The presence of baseline atrial fibrillation was associated with high NT-proBNP at 1 month (i.e. above the median), regardless of the baseline value. After adjustment for patient characteristics and 1-month NT-proBNP level, every twofold increase in continuous NT-proBNP change from baseline to 1 month was predictive of increased cardiovascular mortality or HHF (hazard ratio 1.14; 95% confidence interval 1.02-1.26), but not all-cause mortality (hazard ratio 0.95; 95% confidence interval 0.81-1.11).
  
  
  CONCLUSIONS
  In this cohort of HHF patients with reduced EF, early post-discharge NT-proBNP trajectory was associated with a distinct clinical profile and carried independent prognostic value after adjustment for patient characteristics and absolute NT-proBNP level. Future prospective study of serial NT-proBNP measurement during the hospital and early post-discharge periods is warranted to validate these findings and evaluate post-discharge NT-proBNP trajectory as a therapeutic target.
authors.affiliation: Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, 201 East Huron, Galter 3-150, Chicago, IL 60601, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Greene
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Albert
authors.initials: A
authors.lastname: Kandra
authors.forename: Margaret F
authors.initials: MF
authors.lastname: Prescott
authors.forename: Bernard
authors.initials: B
authors.lastname: Reimund
authors.forename: Tsushung A
authors.initials: TA
authors.lastname: Hua
authors.forename: Anastasia
authors.initials: A
authors.lastname: Lesogor
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D000368:Aged; D000577:Amides / Q000627:therapeutic use; D002908:Chronic Disease; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005650:Fumarates / Q000627:therapeutic use; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D005650:Fumarates; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D000092502:Renin Inhibitors; C109794:pro-brain natriuretic peptide (1-76); C446481:aliskiren
keywords: Heart Failure; Hospitalization; Natriuretic Peptides; Outcomes