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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, Søren L. Jhund, Pardeep Kober, Lars McKelvie, Robert Zile, Michael R. Anand, Inder S. Komajda, Michel Cleland, John G. F. Carson, Peter E. McMurray, John
Kristensen, Søren L.
Jhund, Pardeep
Kober, Lars
McKelvie, Robert
Zile, Michael R.
Anand, Inder S.
Komajda, Michel
Cleland, John G. F.
Carson, Peter E.
McMurray, John
Abstract
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.
Keywords
heart failure, heart failure with preserved ejection fraction, NT-proBNP, outcomes, prognostic markers
Date
2015
Type
Journal article
Journal
JACC: Heart Failure
Book
Volume
3
Issue
6
Page Range
478-486
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
Open access
License
File Access
Controlled