Relative importance of history of heart failure hospitalization and n-terminal pro-b-type natriuretic peptide level as predictors of outcomes in patients with heart failure and preserved ejection fraction
Kristensen, S. L, Jhund, P., Kober, L., McKelvie, R., Zile, M. R, Anand, I. S, Komajda, M., Cleland, J. G, Carson, P. E & McMurray, J. (2015). Relative importance of history of heart failure hospitalization and n-terminal pro-b-type natriuretic peptide level as predictors of outcomes in patients with heart failure and preserved ejection fraction. JACC: Heart Failure,3(6), 478-486. United States: Elsevier Inc.. Retrieved from https://doi.org/10.1016/j.jchf.2015.01.014
Objectives The aim of this study was to investigate N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels and recent heart failure (HF) hospitalization as predictors of future events in heart failure – preserved ejection fraction (HF-PEF). Background Recently, doubt has been expressed about the value of a history of HF hospitalization as a predictor of adverse cardiovascular outcomes in patients with HF and HF-PEF. Methods We estimated rates and adjusted hazard ratios (HRs) for the composite endpoint of cardiovascular death or HF hospitalization, according to history of recent HF hospitalization and baseline NT-proBNP level in the I-PRESERVE (Irbesartan in Heart Failure with Preserved systolic function) trial. Results Rates of composite endpoints in patients with (n = 804) and without (n = 1,963) a recent HF hospitalization were 12.78 (95% confidence interval [CI]: 11.47 to 14.24) and 4.49 (95% CI: 4.04 to 4.99) per 100 person-years, respectively (HR: 2.71; 95% CI: 2.33 to 3.16). For patients with NT-proBNP concentrations >360 pg/ml (n = 1,299), the event rate was 11.51 (95% CI: 10.54 to 12.58) compared to 3.04 (95% CI: 2.63 to 3.52) per 100 person-years in those with a lower level of NT-proBNP (n = 1468) (HR: 3.19; 95% CI: 2.68 to 3.80). In patients with no recent HF hospitalization and NT-proBNP ≤360 pg/ml (n = 1,187), the event rate was 2.43 (95% CI: 2.03 to 2.90) compared with 17.79 (95% CI: 15.77 to 20.07) per 100 person-years when both risk predictors were present (n = 523; HR: 6.18; 95% CI: 4.96 to 7.69). Conclusions Recent hospitalization for HF or an elevated level of NT-proBNP identified patients at higher risk for cardiovascular events, and this risk was increased further when both factors were present.
Mary MacKillop Institute for Health Research
Open Access Journal Article