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Published on: June 10, 2025
Biomarker predictors of cardiac hospitalization in chronic heart failure: a recurrent event analysis
Esther Vorovich1, Benjamin French2, Bonnie Ky2
1Penn Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Insights
Identifying heart failure patients at risk for hospitalization is key. B-type natriuretic peptide (BNP) and troponin I (TnI) best predicted cardiac hospitalizations in chronic heart failure (HF) patients.
Area of Science:
- Cardiology
- Biomarker Research
- Heart Failure Management
Background:
- Heart failure (HF) hospitalization poses significant clinical and economic burdens.
- Predicting HF hospitalizations is crucial for proactive patient management and cost reduction.
- Evaluating novel biomarkers for risk stratification in chronic HF is an ongoing area of research.
Purpose of the Study:
- To assess the predictive value of nine biomarkers for cardiac hospitalization in patients with chronic heart failure.
- To identify which biomarkers are most strongly associated with the risk of recurrent hospitalizations.
- To explore potential differences in biomarker associations based on the etiology of heart failure.
Main Methods:
- A multicenter cohort study included 1,512 outpatients with chronic HF.
- A recurrent events approach was used to analyze the association between biomarkers and cardiac hospitalization.
- Median follow-up was 4 years, during which 843 participants experienced at least one hospitalization.
Main Results:
- B-type natriuretic peptide (BNP) and troponin I (TnI) showed the strongest association with hospitalization risk.
- Soluble Fms-like tyrosine kinase receptor 1 (sFlt-1) also demonstrated a significant association with hospitalization.
- Associations varied between ischemic and non-ischemic HF subgroups, suggesting etiology-specific mechanisms.
Conclusions:
- BNP and TnI are potent predictors of cardiac hospitalization in chronic HF.
- Etiology-dependent associations of other biomarkers suggest distinct HF exacerbation pathways.
- sFlt-1 shows promise as a biomarker for assessing HF morbidity and risk stratification.
Background:
Identification of heart failure (HF) patients at risk for hospitalization may improve care and reduce costs. We evaluated 9 biomarkers as predictors of cardiac hospitalization in chronic HF.
Methods And Results:
In a multicenter cohort of 1,512 chronic HF outpatients, we assessed the association between 9 biomarkers and cardiac hospitalization with the use of a recurrent events approach. Over a median follow-up of 4 years, 843 participants experienced ≥ 1 hospitalizations (total 2,178 hospitalizations). B-type natriuretic peptide (BNP) and troponin I (TnI) exhibited the strongest associations with risk of hospitalization (hazard ratio [HR] 3.8 [95% confidence interval (CI) 2.9-4.9] and HR 3.3 [95% CI 2.8-3.9]; 3rd vs 1st tertiles). Soluble Fms-like tyrosine kinase receptor 1 (sFlt-1) exhibited the next strongest association (HR 2.8 [95% CI 2.4-3.4]), followed by soluble Toll-like receptor 2 (HR 2.3 [95% CI 2.0-2.8]) and creatinine (HR 1.9 [95% CI 1.6-2.4]). Within ischemic/nonischemic subgroups, BNP and TnI remained most strongly associated. Except for creatinine, HRs for all biomarkers studied were smaller within the ischemic subgroup, suggesting greater importance of cardiorenal interactions in decompensation of ischemic HF.
Conclusion:
Although BNP and TnI exhibited the strongest associations with hospitalization, etiology-dependent associations for the remaining biomarkers suggest etiology-specific mechanisms for HF exacerbation. sFlt-1 exhibited a strong association with cardiac hospitalization, highlighting its potential role as a biomarker of HF morbidity.
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