A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: A pilot study

Objectives The goal of this study was to determine if B-type natriuretic pe ptide (BNP) levels predict outcomes of patients admitted with decompensated heart failure. Background Treatment of decompensated congestive heart failure (CHF) has of ten been based on titration of drugs to relieve patient's symptoms, a case that could be made for attempting to also treat neurohormonal abnormalities . Because BNP reflects both elevated left ventricular pressure as well as n eurohormonal modulation, we hypothesized that BNP might be useful in assess ing outcomes in patients admitted with decompensated CHF. Methods We followed 72 patients admitted with decompensated New York Heart Association class III to IV CHF, measuring daily BNP levels. We then determ ined the association between initial BNP measurement and the predischarge o r premoribund BNP measurement and subsequent adverse outcomes (death and 30 -day readmission). Results Of the 72 patients admitted with decompensated CHF, 22 end points o ccurred (death: n = 13, readmission: n = 9). In these patients, BNP levels increased during hospitalization (mean increase, 233 pg/ml, p < 0.001). In patients without end points, BNP decreased (mean decrease 215 pg/ml). Univa riate analysis revealed that the last measured BNP was strongly associated with the combined end point. In patients, surviving hospitalization, BNP di scharge concentrations were strong predictors of subsequent readmission (ar ea under the receiver operator curve of 0.73). Conclusions In patients admitted with decompensated CHF, changes in BNP lev els during treatment are strong predictors for mortality and early readmiss ion. The results suggest that BNP levels might be used successfully to guid e treatment of patients admitted for decompensated CHF. (C) 2001 by the Ame rican College of Cardiology.