Trajectories of Biomarkers Before and After Hospitalization for Heart Failure in Patients With Heart Failure

Hospitalization for heart failure (HF) is associated with poor outcomes, yet the temporal patterns of laboratory biomarkers surrounding such events remain inadequately described. This study aimed to characterize trajectories of routinely measured biomarkers before and after HF hospitalization.

We retrospectively analyzed patients hospitalized for acute HF at Nagoya University Hospital between January 2018 and December 2023. In the main cohort, outpatient levels of B-type natriuretic peptide (BNP), creatinine, hemoglobin, hematocrit, uric acid, sodium, and potassium were evaluated for 1 year following discharge. A second cohort included patients with ≥2 hospitalizations, assessing biomarker trends 1 year before and after the second admission. The main cohort included 709 patients (7,299 laboratory visits). Of them, 191 patients with rehospitalization comprised the second cohort (3,318 visits). In the main cohort, BNP, creatinine, uric acid, hemoglobin, and hematocrit declined for 60 days post-discharge, followed by increases. In the second cohort, BNP, creatinine, and uric acid levels began to rise 60 days before rehospitalization (e.g., BNP increased by 185.2 pg/mL per 30 days, 95% confidence interval: 138.1 to 232.3, P<0.001), while hemoglobin, hematocrit, and sodium declined.

Biomarkers exhibited distinct patterns before and after HF hospitalization. A BNP increase of approximately 200 pg/mL per 30 days within 60 days prior to admission may represent a practical, non-invasive marker to guide early intervention.