BNP-Response to Acute Heart Failure Treatment Identifies High-Risk Population

Achint N. Patel, William N. Southern

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Using serial measurements of Brain Natriuretic Peptide (BNP) has been proposed as a method to guide therapy for patients treated for acute decompensated heart failure. However, 20–47% of patients do not achieve the target BNP thresholds despite treatment. We hypothesised that “BNP unresponsive” patients represent a distinct group at high risk for poor outcomes and sought to examine the characteristics and outcomes of this group. Methods: In a retrospective study using electronic health record (EHR) data, we examined the outcomes of patients admitted with acute decompensated heart failure. Patients were divided into two groups based on their pro-BNP response to treatment: (1) pro-BNP responsive to treatment (decrease by at least 30%) and (2) pro-BNP unresponsive to treatment (decrease by less than 30%). The primary outcomes of interest were 180-day mortality and 180-day readmission. Univariate and multivariate Cox proportional hazard models were used to assess the independent association between pro-BNP response to treatment and 180-day mortality and readmission. Adjustment variables included age, gender, Charlson co-morbidity score, admission creatinine, admission haematocrit, ejection fraction, preserved ejection fraction, and LV end-diastolic dimension. Results: The total study population included 819 patients with 455 (55.6%) in the pro-BNP responsive group and 364 (44.4%) in the pro-BNP unresponsive group. Admissions whose BNP was unresponsive to treatment had significantly increased risk for 180-day mortality, compared with BNP-responsive admissions (26.4% vs. 13.2%, p < 0.001). Brain natriuretic peptide unresponsiveness remained significantly associated with increased 180-day mortality after adjustment for demographic and clinical characteristics (HR adj = 2.19, 95% CI: 1.52–3.14). BNP-unresponsiveness was not associated with significantly increased 180-day readmission rates (HR adj = 1.07, 95% CI: 0.92–1.25). Conclusions: Patients whose pro-BNP did not improve by >30% were at increased risk for 180-day mortality, but not 180-day readmission. Thus, BNP-unresponsiveness provides meaningful prognostic information, and it may define a patient population that would benefit from specific therapies to reduce the risk.

Original languageEnglish (US)
JournalHeart Lung and Circulation
DOIs
StatePublished - Jan 1 2019

Fingerprint

Brain Natriuretic Peptide
Heart Failure
Population
Therapeutics
Mortality
Electronic Health Records
Hematocrit
Proportional Hazards Models

Keywords

  • Heart failure
  • Mortality
  • Natriuretic peptides
  • Prognosis
  • Readmission

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

BNP-Response to Acute Heart Failure Treatment Identifies High-Risk Population. / Patel, Achint N.; Southern, William N.

In: Heart Lung and Circulation, 01.01.2019.

Research output: Contribution to journalArticle

@article{ca3aa80385ea4bb78cc98bd60c0be0cd,
title = "BNP-Response to Acute Heart Failure Treatment Identifies High-Risk Population",
abstract = "Background: Using serial measurements of Brain Natriuretic Peptide (BNP) has been proposed as a method to guide therapy for patients treated for acute decompensated heart failure. However, 20–47{\%} of patients do not achieve the target BNP thresholds despite treatment. We hypothesised that “BNP unresponsive” patients represent a distinct group at high risk for poor outcomes and sought to examine the characteristics and outcomes of this group. Methods: In a retrospective study using electronic health record (EHR) data, we examined the outcomes of patients admitted with acute decompensated heart failure. Patients were divided into two groups based on their pro-BNP response to treatment: (1) pro-BNP responsive to treatment (decrease by at least 30{\%}) and (2) pro-BNP unresponsive to treatment (decrease by less than 30{\%}). The primary outcomes of interest were 180-day mortality and 180-day readmission. Univariate and multivariate Cox proportional hazard models were used to assess the independent association between pro-BNP response to treatment and 180-day mortality and readmission. Adjustment variables included age, gender, Charlson co-morbidity score, admission creatinine, admission haematocrit, ejection fraction, preserved ejection fraction, and LV end-diastolic dimension. Results: The total study population included 819 patients with 455 (55.6{\%}) in the pro-BNP responsive group and 364 (44.4{\%}) in the pro-BNP unresponsive group. Admissions whose BNP was unresponsive to treatment had significantly increased risk for 180-day mortality, compared with BNP-responsive admissions (26.4{\%} vs. 13.2{\%}, p < 0.001). Brain natriuretic peptide unresponsiveness remained significantly associated with increased 180-day mortality after adjustment for demographic and clinical characteristics (HR adj = 2.19, 95{\%} CI: 1.52–3.14). BNP-unresponsiveness was not associated with significantly increased 180-day readmission rates (HR adj = 1.07, 95{\%} CI: 0.92–1.25). Conclusions: Patients whose pro-BNP did not improve by >30{\%} were at increased risk for 180-day mortality, but not 180-day readmission. Thus, BNP-unresponsiveness provides meaningful prognostic information, and it may define a patient population that would benefit from specific therapies to reduce the risk.",
keywords = "Heart failure, Mortality, Natriuretic peptides, Prognosis, Readmission",
author = "Patel, {Achint N.} and Southern, {William N.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.hlc.2019.02.004",
language = "English (US)",
journal = "Heart Lung and Circulation",
issn = "1443-9506",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - BNP-Response to Acute Heart Failure Treatment Identifies High-Risk Population

AU - Patel, Achint N.

AU - Southern, William N.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Using serial measurements of Brain Natriuretic Peptide (BNP) has been proposed as a method to guide therapy for patients treated for acute decompensated heart failure. However, 20–47% of patients do not achieve the target BNP thresholds despite treatment. We hypothesised that “BNP unresponsive” patients represent a distinct group at high risk for poor outcomes and sought to examine the characteristics and outcomes of this group. Methods: In a retrospective study using electronic health record (EHR) data, we examined the outcomes of patients admitted with acute decompensated heart failure. Patients were divided into two groups based on their pro-BNP response to treatment: (1) pro-BNP responsive to treatment (decrease by at least 30%) and (2) pro-BNP unresponsive to treatment (decrease by less than 30%). The primary outcomes of interest were 180-day mortality and 180-day readmission. Univariate and multivariate Cox proportional hazard models were used to assess the independent association between pro-BNP response to treatment and 180-day mortality and readmission. Adjustment variables included age, gender, Charlson co-morbidity score, admission creatinine, admission haematocrit, ejection fraction, preserved ejection fraction, and LV end-diastolic dimension. Results: The total study population included 819 patients with 455 (55.6%) in the pro-BNP responsive group and 364 (44.4%) in the pro-BNP unresponsive group. Admissions whose BNP was unresponsive to treatment had significantly increased risk for 180-day mortality, compared with BNP-responsive admissions (26.4% vs. 13.2%, p < 0.001). Brain natriuretic peptide unresponsiveness remained significantly associated with increased 180-day mortality after adjustment for demographic and clinical characteristics (HR adj = 2.19, 95% CI: 1.52–3.14). BNP-unresponsiveness was not associated with significantly increased 180-day readmission rates (HR adj = 1.07, 95% CI: 0.92–1.25). Conclusions: Patients whose pro-BNP did not improve by >30% were at increased risk for 180-day mortality, but not 180-day readmission. Thus, BNP-unresponsiveness provides meaningful prognostic information, and it may define a patient population that would benefit from specific therapies to reduce the risk.

AB - Background: Using serial measurements of Brain Natriuretic Peptide (BNP) has been proposed as a method to guide therapy for patients treated for acute decompensated heart failure. However, 20–47% of patients do not achieve the target BNP thresholds despite treatment. We hypothesised that “BNP unresponsive” patients represent a distinct group at high risk for poor outcomes and sought to examine the characteristics and outcomes of this group. Methods: In a retrospective study using electronic health record (EHR) data, we examined the outcomes of patients admitted with acute decompensated heart failure. Patients were divided into two groups based on their pro-BNP response to treatment: (1) pro-BNP responsive to treatment (decrease by at least 30%) and (2) pro-BNP unresponsive to treatment (decrease by less than 30%). The primary outcomes of interest were 180-day mortality and 180-day readmission. Univariate and multivariate Cox proportional hazard models were used to assess the independent association between pro-BNP response to treatment and 180-day mortality and readmission. Adjustment variables included age, gender, Charlson co-morbidity score, admission creatinine, admission haematocrit, ejection fraction, preserved ejection fraction, and LV end-diastolic dimension. Results: The total study population included 819 patients with 455 (55.6%) in the pro-BNP responsive group and 364 (44.4%) in the pro-BNP unresponsive group. Admissions whose BNP was unresponsive to treatment had significantly increased risk for 180-day mortality, compared with BNP-responsive admissions (26.4% vs. 13.2%, p < 0.001). Brain natriuretic peptide unresponsiveness remained significantly associated with increased 180-day mortality after adjustment for demographic and clinical characteristics (HR adj = 2.19, 95% CI: 1.52–3.14). BNP-unresponsiveness was not associated with significantly increased 180-day readmission rates (HR adj = 1.07, 95% CI: 0.92–1.25). Conclusions: Patients whose pro-BNP did not improve by >30% were at increased risk for 180-day mortality, but not 180-day readmission. Thus, BNP-unresponsiveness provides meaningful prognostic information, and it may define a patient population that would benefit from specific therapies to reduce the risk.

KW - Heart failure

KW - Mortality

KW - Natriuretic peptides

KW - Prognosis

KW - Readmission

UR - http://www.scopus.com/inward/record.url?scp=85063056114&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063056114&partnerID=8YFLogxK

U2 - 10.1016/j.hlc.2019.02.004

DO - 10.1016/j.hlc.2019.02.004

M3 - Article

AN - SCOPUS:85063056114

JO - Heart Lung and Circulation

JF - Heart Lung and Circulation

SN - 1443-9506

ER -