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Predictors of Six-Month Mortality in BNP-Matched Acute Heart Failure Patients
Patrícia Lourenço1, Ana Ribeiro1, Mariana Pintalhão2
1Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal.
Insights
In acute heart failure (HF), a significant decrease in B-type natriuretic peptide (BNP) levels during hospitalization independently predicts better survival. This finding highlights BNP reduction as a key prognostic indicator in HF management.
Area of Science:
- Cardiology
- Clinical Medicine
- Biomarkers
Background:
- Natriuretic peptides, particularly B-type natriuretic peptide (BNP), are established prognostic markers in heart failure (HF).
- The independent prognostic value of other clinical and laboratory variables in acute HF remains to be fully elucidated.
- Understanding predictors of mortality is crucial for optimizing patient management and outcomes.
Purpose of the Study:
- To identify independent predictors of 6-month mortality in patients hospitalized with acute heart failure.
- To specifically assess prognostic determinants in patients matched for admission B-type natriuretic peptide (BNP) levels.
- To clarify the role of BNP decrease during hospitalization as a mortality predictor.
Main Methods:
- A retrospective case-control study was conducted using a prospectively recruited cohort of hospital-admitted acute HF patients.
- 112 patients who died within 6 months (cases) were matched with 112 survivors (controls) based on age, gender, and admission BNP levels.
- Cox regression analysis, including a multivariate model, was used to analyze prognostic predictors of death.
Main Results:
- The study analyzed 224 patients (112 deaths, 112 survivors) with a median age of 80 years.
- Survivors exhibited higher admission systolic blood pressure and heart rate, higher hemoglobin, lower urea, and a greater decrease in BNP during hospitalization.
- Multivariate analysis identified a >30% decrease in BNP during hospitalization as the sole independent predictor of mortality (Hazard Ratio: 0.57).
Conclusions:
- In acute heart failure patients matched for admission BNP levels, a significant decrease in BNP during hospitalization is the only independent predictor of 6-month mortality.
- This suggests that other previously identified mortality predictors may not be independent of natriuretic peptide levels.
- BNP reduction serves as a critical prognostic indicator in acute HF, potentially guiding therapeutic adjustments.
Abstract:
Natriuretic peptides have established prognostic value in heart failure (HF). The role of many other clinical and laboratory variables is still to be proved. The aim of this study was to assess prognostic determinants of death in acute HF in B-type natriuretic peptide (BNP)-matched patients. We conducted a case-control study to assess prognostic predictors of 6-month mortality in acute HF. From a prospectively recruited population of hospital-admitted patients with acute HF, we retrospectively selected a convenience sample of age-, gender-, and admission BNP-matched patients who survived (controls) or died (cases) in the follow-up period. Prognostic predictors of death were analyzed using a Cox regression analysis. A multivariate model was built. Variables in the model included atrial fibrillation, hypertension, admission heart rate, systolic blood pressure, the New York Heart Association class, hemoglobin, urea, albumin, systolic dysfunction, ischemic etiology, prognostic-modifying therapy, and BNP decrease during hospitalization. We analyzed 224 patients: 112 surviving and 112 not surviving a 6-month period. Median age was 80 years, 42.9% of the patients were men, and 63.9% had systolic dysfunction. Patients surviving the first 6 months had higher admission systolic blood pressure and heart rate, higher hemoglobin, lower urea, and more often had >30% decrease in BNP during hospitalization; they were more often discharged on HF prognostic modifying therapy. However, in multivariate analysis, the only independent mortality predictor was BNP decrease: patients in whom BNP decreased >30% had an HR of death of 0.57 (0.37 to 0.89). In conclusion, in BNP-matched patients with acute HF, the only independent mortality predictor is BNP decrease. Other literature suggested death predictors do not seem independent of natriuretic peptides.
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