Prognostic Significance of I-Month Postdischarge BNP in Identifying Patients at High Risk of Mortality and Readmission After Decompensated Heart Failure

Objective: The B-type natriuretic peptide (BNP) levels could predict future cardiovascular events in congestive heart failure patients. Most studies have correlated basal BNP levels to long-term outcomes. Limited data exist on the prognostic significance of 1-month postdischarge BNP levels after acute heart failure.Methods: Consecutive patients admitted for worsening heart failure were enrolled. BNP was measured at admission, predischarge and at 1-month following discharge. Patients were followed for 1 year for end points of death and rehospitalization.Results: A total of 150 patients (mean age 60.8 + 13.8 years) were included in the heart failure study. 81 (54%) patients had acute heart failure secondary to acute coronary syndrome, while the rest (46%) had acute decompensation of chronic heart failure irrespective of etiology. Mean ejection fraction was 28.6 + 8.9%. 14 patients expired during hospitalization. BNP at admission was an important predictor of in hospital mortality ( P value = .003). Following discharge, 7 events (3 deaths and 4 rehospitalizations) occurred over next 1 month. 1-month outcome was predicted by baseline BNP ( P value = .01) as well as discharge BNP value ( P value = .001). A total of 55 events (26 rehospitalization and 29 deaths) occurred at follow-up of 1 year. Age > 50years, ejection fraction at baseline and all time sequential BNP levels (at admission, discharge, as well as 1 month) were univariate predictors of death and rehospitalization at 1 year. The BNP at 1 month had best discriminative power and remained the lone significant predictor in the multivariate analysis ( P = < .001).Conclusions: 1-month postdischarge BNP level is a useful prognostic factor that predicts mortality and rehospitalization at 1-year follow-up, in patients admitted with heart failure, and helps in identifying patients who need more intensive drug treatment and closer follow-up.