title: Relative Importance of History of Heart Failure Hospitalization and N-Terminal Pro-B-Type Natriuretic Peptide Level as Predictors of Outcomes in Patients With Heart Failure and Preserved Ejection Fraction.
abstract: OBJECTIVE
  The aim of this study was to investigate N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and recent heart failure (HF) hospitalization as predictors of future events in heart failure - preserved ejection fraction (HF-PEF).
  
  
  BACKGROUND
  Recently, doubt has been expressed about the value of a history of HF hospitalization as a predictor of adverse cardiovascular outcomes in patients with HF and HF-PEF.
  
  
  METHODS
  We estimated rates and adjusted hazard ratios (HRs) for the composite endpoint of cardiovascular death or HF hospitalization, according to history of recent HF hospitalization and baseline NT-proBNP level in the I-PRESERVE (Irbesartan in Heart Failure with Preserved systolic function) trial.
  
  
  RESULTS
  Rates of composite endpoints in patients with (n = 804) and without (n = 1,963) a recent HF hospitalization were 12.78 (95% confidence interval [CI]: 11.47 to 14.24) and 4.49 (95% CI: 4.04 to 4.99) per 100 person-years, respectively (HR: 2.71; 95% CI: 2.33 to 3.16). For patients with NT-proBNP concentrations >360 pg/ml (n = 1,299), the event rate was 11.51 (95% CI: 10.54 to 12.58) compared to 3.04 (95% CI: 2.63 to 3.52) per 100 person-years in those with a lower level of NT-proBNP (n = 1468) (HR: 3.19; 95% CI: 2.68 to 3.80). In patients with no recent HF hospitalization and NT-proBNP ≤360 pg/ml (n = 1,187), the event rate was 2.43 (95% CI: 2.03 to 2.90) compared with 17.79 (95% CI: 15.77 to 20.07) per 100 person-years when both risk predictors were present (n = 523; HR: 6.18; 95% CI: 4.96 to 7.69).
  
  
  CONCLUSIONS
  Recent hospitalization for HF or an elevated level of NT-proBNP identified patients at higher risk for cardiovascular events, and this risk was increased further when both factors were present.
authors.affiliation: BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom; Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Søren L
authors.initials: SL
authors.lastname: Kristensen
authors.affiliation: BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors.forename: Pardeep S
authors.initials: PS
authors.lastname: Jhund
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
authors.affiliation: Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.affiliation: Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.affiliation: Harefield Hospital, Imperial College, London, United Kingdom.
authors.forename: John G F
authors.initials: JGF
authors.lastname: Cleland
authors.affiliation: Washington DC Veterans Affairs Medical Center and Georgetown University, Washington, DC.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Carson
authors.affiliation: BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom. Electronic address: john.mcmurray@glasgow.ac.uk.
authors.forename: John J V
authors.initials: JJV
authors.lastname: McMurray
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: NT-proBNP outcomes; heart failure; heart failure with preserved ejection fraction; prognostic markers