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Pre‐discharge B‐type natriuretic peptide predicts early recurrence of decompensated heart failure in patients admitted to a general medical unit
Author(s) -
Verdiani Valerio,
Nozzoli Carlo,
Bacci Francesca,
Cecchin Adriana,
Rutili Maria Serena,
Paladini Sergio,
Olivotto Iacopo
Publication year - 2005
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2004.12.006
Subject(s) - medicine , heart failure , natriuretic peptide , percentile , hazard ratio , cardiology , nesiritide , hospital readmission , hospital discharge , emergency medicine , confidence interval , statistics , mathematics
Background B‐type natriuretic peptide (BNP) represents a promising predictor of early (30 days) re‐admission in patients with heart failure (HF) admitted to cardiology units. Whether BNP retains its predictive value in unselected patients admitted to general medical wards is unknown. Methods We determined BNP levels on admission and pre‐discharge in 100 consecutive patients (71 male, mean age 78±10 years) admitted to a general medical unit due to decompensated HF. Follow‐up after discharge was 30 days. Results Of the 100 patients, 86 had ≥1 comorbid conditions. Median BNP was 739 pg/ml on admission (25th–75th percentile 355–1333 pg/ml, respectively), and 414 pg/ml pre‐discharge (25th–75th percentile 220–696 pg/ml). Seventeen patients were re‐admitted or died within 30 days. Patients with pre‐discharge BNP values >75th percentile (696 pg/ml) had greater risk of re‐hospitalisation, as compared to values ≤696 pg/ml (56% vs. 4%, respectively; p <0.001). Negative predictive value for this cut‐off was 96%. BNP values >75th percentile were associated with a 15.0 independent relative hazard (RH) of early re‐admission or death (95% CI 4.2–53.8; p <0.0001). The other independent predictor was a NYHA class ≥III at discharge (RH 2.9; 95% CI 1.1–9.3; p <0.05). Conclusion In a general medical unit, pre‐discharge BNP levels were a strong independent predictor of early re‐admission or death due to HF, irrespective of substantial comorbidity and advanced age.