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Post-discharge rise in BNP and rehospitalization for heart failure

Anstieg des BNP-Werts nach Entlassung und stationäre Wiederaufnahme wegen Herzinsuffizienz

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Abstract

Background

The B‑type natriuretic peptide (BNP) level on discharge of patients hospitalized with decompensated heart failure (HF) is widely considered as the “baseline” value, and treatment should be targeted to maintain this level. The prognostic value of an increase in BNP level from discharge to the 1‑month follow-up in predicting rehospitalization has not been previously explored.

Methods

The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial data were utilized to determine whether an increase in BNP level from discharge to the 1‑month follow-up is associated with a higher risk of rehospitalization. The study endpoints were all-cause rehospitalization up to 6 months following randomization.

Results

Among 44 patients (mean age, 56 years, 71% men) who had their BNP levels checked on discharge and at the 1‑month follow-up, the average BNP level on discharge of the whole cohort was 467 pg/ml, which increased to 919 pg/ml at 1 month (p = 0.001). The median and interquartile range of the magnitude of rise in BNP level from discharge to 1‑month follow-up was higher in rehospitalized compared with non-rehospitalized patients (329 [11, 956] vs. 44 [−90, 316] pg/ml, p = 0.039, in both groups, respectively). Receiver operator characteristic curves showed that the magnitude of the rise in BNP from discharge to the 1‑month follow-up had an area under the curve of 0.686 (p = 0.0255) in predicting all-cause rehospitalization. Rehospitalized and non-rehospitalized patients had similar degree of clinical congestion and comparable BNP level on hospital discharge.

Conclusion

The magnitude of the rise in BNP level from discharge to the 1‑month follow-up is a useful prognostic factor that predicts rehospitalization in patients with HF.

Zusammenfassung

Hintergrund

Der Wert des natriuretischen Peptids vom B‑Typ („B-type natriuretic peptide“, BNP) bei Entlassung von Patienten, die wegen dekompensierter Herzinsuffizienz stationär aufgenommen worden waren, wird weithin als „Ausgangswert“ betrachtet, und die Behandlung sollte sich auf den Erhalt dieses Werts ausrichten. In Hinblick auf die Vorhersage einer stationären Wiederaufnahme ist der prognostische Nutzen eines BNP-Wert-Anstiegs von der Entlassung bis zur Nachuntersuchung nach einem Monat bisher nicht untersucht worden.

Methoden

Die Daten der Studie Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) wurden verwendet, um zu untersuchen, ob ein Anstieg des BNP-Werts von der Entlassung bis zur Nachuntersuchung nach einem Monat mit einem höheren Risiko für eine erneute stationäre Aufnahme verbunden ist. Studienendpunkt war die stationäre Wiederaufnahme aus sämtlichen Gründen bis zu 6 Monate nach Randomisierung.

Ergebnisse

Für 44 Patienten (Durchschnittsalter: 56 Jahre, 71% m.), bei denen der BNP-Wert zur Entlassung und anlässlich der Nachuntersuchung nach einem Monat bestimmt wurde, betrug der Durchschnitts-BNP-Wert der ganzen Kohorte bei Entlassung 467 pg/ml und stieg auf 919 pg/ml nach einem Monat (p = 0,001). Der Mittelwert und Interquartilsabstand des BNP-Anstiegs von der Entlassung bis zur Nachuntersuchung nach einem Monat war bei den stationär Wiederaufgenommenen höher als bei denen, die nicht erneut stationär aufgenommen worden waren (329 [11, 956] vs. 44 [−90, 316] pg/ml; p = 0,039, in beiden Gruppen). Die Receiver-Operator-Characteristic-Kurven zeigten, dass die Größe des Anstiegs beim BNP-Wert von der Entlassung bis zur Nachuntersuchung nach einem Monat eine Fläche unter der Kurve (AUC) von 0,686 (p = 0,0255) bei der Vorhersage der stationären Wiederaufnahme aus sämtlichen Gründen aufwies. Stationär wiederaufgenommene und nicht wiederaufgenommene Patienten hatten einen ähnlichen Grad klinischer Kongestion und vergleichbare BNP-Spiegel bei der Entlassung aus dem Krankenhaus.

Schlussfolgerung

Die Größe des Anstiegs des BNP-Werts von der Entlassung bis zur Nachuntersuchung nach einem Monat ist ein nützlicher prognostischer Parameter zur Vorhersage der stationären Wiederaufnahme bei Patienten mit Herzinsuffizienz.

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Acknowledgements

The ESCAPE trial was conducted and supported by the NHLBI in collaboration with the ESCAPE Study Investigators. This article was prepared using a limited access dataset obtained from the NHLBI and does not necessarily reflect the opinions or views of the ESCAPE trial investigators or the NHLBI.

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Authors and Affiliations

  1. Internal Medicine Department, Mercy Medical Center, Clinton, IA, USA

    H. R. Omar MD

  2. Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, USA

    M. Guglin MD

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  1. H. R. Omar MD
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  2. M. Guglin MD
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Correspondence to H. R. Omar MD.

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H.R. Omar and M. Guglin declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Omar, H.R., Guglin, M. Post-discharge rise in BNP and rehospitalization for heart failure. Herz 44, 450–454 (2019). https://doi.org/10.1007/s00059-018-4687-1

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