Are Biomarkers the Answer to the Heart Failure Readmissions Problem?

Readmissions after hospitalization for heart failure (HF)3 are an increasingly important problem, with 1 in 4 patients rehospitalized within 30 days of discharge. Given the economic and public health implications of readmissions, several health care–related institutes and payers have focused on this metric as an indicator of the quality of care. On October 1, 2012, the Centers for Medicare and Medicaid Services (CMS) began to financially penalize hospitals with higher than expected 30-day readmission rates for pneumonia, acute myocardial infarction, and HF. This has led to advocacy for a variety of approaches to reduce readmissions, including improved coordination of care in the postdischarge period, earlier postdischarge follow-up, more home-based follow-up, and enhanced patient education and self-management. Because biomarkers play an important role in the diagnosis and management of HF, there has been interest in understanding their potential as part of a strategy to reduce readmissions.There are two potential roles for the use of biomarkers in a strategy to reduce readmissions in HF. First, biomarkers may help to predict which patients are at increased risk for readmission. Second, monitoring serial values in the outpatient setting may allow for early intervention aimed at reducing readmissions. Although the use of biomarkers in identifying patients at highest risk for readmissions seems like a natural extension of their current use, there are several problems to address.What biomarkers would be most useful in this setting? Although a wide variety of biomarkers have been demonstrated to predict death in patients with HF, their record is more mixed in regard to predicting readmission. Natriuretic peptides are the most commonly used markers in this regard. In a single-center study of patients admitted with acute decompensated HF, B-type natriuretic peptide (BNP) measured at hospital discharge was a strong predictor of 1-year mortality, having an area under the …