Admission, Discharge, or Change in B-Type Natriuretic Peptide and Long-Term Outcomes: Data From Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) Linked to Medicare Claims

Study Questions:

What measure of B-type natriuretic peptide (BNP)—admission, discharge, or the change from admission to discharge—best predicts 1-year mortality and/or re-hospitalization?

Methods:

This was a retrospective study in which patients ≥65 years of age in the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry were linked to Medicare claims. Among patients with recorded admission and discharge BNP, models that predicted 1-year mortality and/or re-hospitalization were compared, accounting for clinical variables alone and clinical variables and different measures of BNP.

Results:

Observed 1-year mortality and 1-year mortality or re-hospitalization rates were 35.2% and 79.4%, respectively. After adjustment for patient characteristics, the model containing discharge level of BNP was best able to predict 1-year mortality (c-index, 0.693) and 1-year mortality or re-hospitalization (c-index, 0.606).

Conclusions:

Among older patients hospitalized for heart failure, discharge BNP, when compared to other clinical variables and different measures of BNP, best predicts 1-year mortality and/or re-hospitalization.

Perspective:

While limited by a retrospective study design, the current study points to the predictive ability of discharge BNP among HF patients at the time of hospital discharge. Based on this predictive ability, there may be a role for discharge BNP in informing the intensity of outpatient interventions following discharge or enrollment into disease management programs aimed at avoiding readmissions.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Heart Diseases, Biological Markers, Patient Readmission, Troponin I, Heart Failure, Medicare, United States, Natriuretic Peptide, Brain


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