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. S. , Køber, L., McKelvie, R. S., Zile, M. R., Anand, I. S., Komajda, M., Cleland, J. G.F. , Carson, P. E. and McMurray, J. J.V. (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), pp. 478-486. (doi: 10.1016/j.jchf.2015.01.014) (PMID:26046842)

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kristensen, Mr Soren Lund and Jhund, Professor Pardeep and McMurray, Professor John and Cleland, Professor John
• Authors: Kristensen, S. L., Jhund, P. S., Køber, L., McKelvie, R. S., Zile, M. R., Anand, I. S., Komajda, M., Cleland, J. G.F., Carson, P. E., and McMurray, J. J.V.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: JACC: Heart Failure
• Publisher: American College of Cardiology Foundation
• ISSN: 2213-1779
• ISSN (Online): 2213-1787
• Published Online: 01 June 2015
• Copyright Holders: Copyright © 2015 American College of Cardiology Foundation
• First Published: First published in JACC: Heart Failure 3(6):478-786
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher.