Discharge BNP Bests BNP Change for Long-Term HF Risk Prediction

September 23, 2010

September 23, 2010 (San Diego, California)— Centers that rely on change in natriuretic-peptide levels for assessing long-term risk in their patients hospitalized with heart failure can do better by simply focusing on discharge levels, according to an analysis based on Medicare beneficiaries in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) registry [1].

Dr G Michael Felker

Three strategies for using brain-natriuretic-peptide (BNP) levels to predict one-year outcomes--admission BNP only, the ratio of discharge to admission BNP, and discharge BNP only--were compared for >16 000 of patients at 259 hospitals, reported Dr G Michael Felker (Duke University, Durham, NC) last week at the Heart Failure Society of America 2010 Scientific Meeting. The cohort's median age was 80 years.

Multivariate predictive models suggested that of the three strategies, the discharge-BNP model "was the most robust and had the best discrimination" for one-year mortality. "So it seems to be true that no matter where you started, or even how much you had changed, it's where you ended up that provides the most long-term prognostic information," Felker observed.

In further analysis, the addition of discharge BNP to risk prediction based solely on clinical criteria led to reclassification of risk status for a fourth of the cohort, he said. Those who changed status included:

  • 15.6% of the 2175 patients who were clinically high risk; nearly all of whom went from high to intermediate risk after the addition of discharge BNP.

  • 37% of the 2117 patients at clinically intermediate risk; adding discharge BNP reclassified just over half to low risk and the rest to high-risk status.

  • 12.3% of the 2155 who were clinically low risk, virtually all of whom were reclassified to intermediate risk with the addition of discharge BNP.

Asked during the question-and-answer period if he would "stick his neck out" and name a BNP level or change in level that signifies a patient is ready for discharge, Felker said, "Lower is always better. Often you hear people [say it should be] a 30% drop. Our data would say that maybe that's not as adequate as just getting it as low as you possibly can."

The OPTIMIZE-HF registry was supported by GlaxoSmithKline. Felker reports consulting and research for Roche Diagnostics.


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