Inpatient monitoring and prognostic importance of B-type natriuretic peptide

Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in many industrialized countries. Despite a consistent body of data demonstrating the benefits of drug therapy, the prognosis of patients admitted with ADHF remains dismal, as it is associated with high readmission and mortality rates within 6 months of admission. ADHF is a largely hemodynamic disorder; 90% of hospitalized patients present with volume overload. Neurohormonal activation characterizes the disease; the B-type natriuretic peptide (BNP) and N-terminal prohormone brain natriuretic peptide are natriuretic and vasodilating peptides released from the cardiac ventricles as a response to ventricular volume expansion and relate to outcome. While BNP levels obtained on admission provide independent prognostic information of in-hospital mortality, BNP levels during and at the completion of hospitalization can help to achieve euvolemia and may reflect adequacy of treatment. Once euvolemia is reached, BNP level correlated with functional class and prognosis. Studies using natriuretic peptides have suggested that predischarge BNP level appeared to be the strongest predictor for identifying subsequent death or hospital admission at 6 months. The addition of predischarge BNP levels to a clinical/instrumental decisional score for discharge decision should make possible the detection of high-risk patients who need reinforced treatment or follow-up.