B-type natriuretic peptide (BNP) on discharge as marker of mortality on patients presenting HF with reduced Ejection Fraction (HFrEF) for two years follow-up.

Cristian Gabriel Bejan, Ioana Camelia Teleanu, Ioana Veronica Grajdeanu, Elena Valentina Vacarel, Ana Maria Alexandra Stanescu

Keywords: NT-proBNP on discharge, HFpEF, mortality, utility in family medicine

Background:

Heart failure affects 1-2% of the Western population. It is imperative to recognize the importance of the biomarker NT-pro BNP in diagnosing heart failure. By utilizing NT-proBNP as a surrogate marker, the diagnosis and management of this condition can be significantly improved. However, it is essential to conduct further research on large population groups to integrate Nt-proBNP values into programs for family doctors. This integration will not only assist in monitoring symptomatic patients but will also improve the triage methods.

Research questions:

By determining NT pro-BNP in symptomatic patients (dyspnea and edema), can new cases of HF be diagnosed in primary care?
Does NT pro-BNP monitoring in patients with HF prevent premature death in such patients?

Method:

We performed a prospective 2-year follow-up study of heart failure patients with low ejection fractions in which we determined NT proBNP as a surrogate marker of death risk. We analyzed a group of 96 patients presenting heart failure with reduced ejection fraction using Cox regression that NT-proBNP on admission and discharge predicts mortality during a year's follow-up period.

Results:

We determined that the NT pro-BNP threshold value on discharge is 8700pg/ml (75,9% sensibility and 68.7% specificity), where mortality risk rises by 4.6 times 95% CI (2-10.8) p 0.001. As predictors of raising NT pro-BNP on discharge >8700pg/ml found that without angiotensin-converting enzyme inhibitors (ACEi) treatment (OR 3.4, p 0.008), systolic blood pressure on admission ≤120mmHg (OR 3.4, p 0.009), hemoglobin on admission ≤11.7g/dL (OR 3.2, p 0.007 and age >82 years old (OR 4.7, p 0.002).

Conclusions:

The NT pro-BNP threshold value on the discharge of 8700pg/ml will raise mortality risk by 4.6 times in patients with HFpEF in the next two years. We consider that monitoring of patients with heart failure is necessary to avoid the risk of death or hospitalization.

Points for discussion:

Monitoring of NT pro-BNP in primary care to avoid the risk of death

Can we use NT pro-BNP values for the diagnosis of heart failure?

Possibilities and limitations

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