Italian RED Study Sub-Analysis: 30-Day Post-Discharge BNP Levels Predict 6-Month All-Cause Mortality and Cardiac Events

Introduction:Rehospitalization of patients after acute decompensated heart failure (ADHF) is a major medical problem. B-type natriuretic peptide (BNP) levels are very prognostic at discharge, but their role in the weeks after discharge have not been elucidated. Hypothesis:Our aim was to determine if BNP levels after discharge for ADHF had significant prognostic ability. Methods: This was a 8 center Italian observational study. 287 patients with ADHF were studied with physical exams, lab tests, CXR, ECGs and BNP values at admission, 24 hours, discharge, and 30/90/180-day post-discharge. In this analysis, 104 patients were included whom were all recruited at the main study site. This population had more hypertension, coronary artery disease, and beta-blocker use in the hospital. Logistic regression and receiver operating characteristic (ROC) curves were used to assess the ability of BNP levels at 30 days post-discharge to predict future events up to 6 months. Results: Of the 104 patients, 15 had events (all-cause mortality, re-hospiatlization, or cardiac events) within 6 months of discharge from the hospital. Logistic regression demonstrated that BNP levels 30 days post-discharge were significantly predictive of future events (OR=12.2, p=0.03)..Discharge levels were not predictive of future events. On ROC analysis, BNP values above 400 pg/mL at 30 days had the maximum area under curve at 0.780. Conclusion: Our analysis demonstrates that 30-day BNP levels post-discharge also have significant prognostic value. Patients with BNP levels greater than 400 pg/mL 1 month after discharge should be considered high risk for hospitalization and death, and considered to optimize therapeutic and preventative strategies