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B-type natriuretic Peptide-guided treatment for predicting outcome in patients hospitalized in sub-intensive care unit with acute heart failure.
J Card Fail. 2008 Apr; 14(3):219-24.JC

Abstract

BACKGROUND

Studies with natriuretic peptides have suggested that physicians do not treat heart acute failure (AHF) aggressively enough, and predischarge B-type natriuretic peptide (BNP) levels may be a useful reminder that more treatment is required. The purpose of this study was to demonstrate that variations in BNP levels during hormone-guided treatment and measured body hydration status enable the timing of the patient's discharge to be optimized.

METHODS AND RESULTS

We retrospectively evaluated 186 patients admitted for AHF. All subjects underwent serial bioelectrical impedance analysis and BNP measurement. Therapy was titrated according to BNP value to reach a BNP value of <250 pg/mL, whenever is possible. A BNP value on discharge of <250 pg/mL (obtained in 54% of the patients) predicted a 16% event rate within 6 months, whereas a value >250 pg/mL was associated with a far higher percentage (78%) of adverse events. Among the former, no significant differences in event rate were seen in relation to the time necessary to obtain a reduction in BNP values below 250 pg/mL (14 versus 18%, chi-square = 0.3, NS). Cox regression showed that a BNP cutoff value of 250 pg/mL is the most accurate predictors of events.

CONCLUSIONS

Our study demonstrates the usefulness of BNP in intrahospital stratification of AHF, in the decision-making process, and as a tool for "tailored therapy." Integrating this approach into the routine assessment of HF patients would allow clinicians to more accurately identify high-risk patients, who may derive increased benefit from intensive in-hospital management strategies.

Authors+Show Affiliations

Heart Failure Unit, Department of Cardiology, Ospedale Civile, S. Donà di Piave - Venice.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18381185

Citation

Valle, Roberto, et al. "B-type Natriuretic Peptide-guided Treatment for Predicting Outcome in Patients Hospitalized in Sub-intensive Care Unit With Acute Heart Failure." Journal of Cardiac Failure, vol. 14, no. 3, 2008, pp. 219-24.
Valle R, Aspromonte N, Giovinazzo P, et al. B-type natriuretic Peptide-guided treatment for predicting outcome in patients hospitalized in sub-intensive care unit with acute heart failure. J Card Fail. 2008;14(3):219-24.
Valle, R., Aspromonte, N., Giovinazzo, P., Carbonieri, E., Chiatto, M., di Tano, G., Feola, M., Milli, M., Fontebasso, A., Barro, S., Bardellotto, S., & Milani, L. (2008). B-type natriuretic Peptide-guided treatment for predicting outcome in patients hospitalized in sub-intensive care unit with acute heart failure. Journal of Cardiac Failure, 14(3), 219-24. https://doi.org/10.1016/j.cardfail.2007.10.009
Valle R, et al. B-type Natriuretic Peptide-guided Treatment for Predicting Outcome in Patients Hospitalized in Sub-intensive Care Unit With Acute Heart Failure. J Card Fail. 2008;14(3):219-24. PubMed PMID: 18381185.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - B-type natriuretic Peptide-guided treatment for predicting outcome in patients hospitalized in sub-intensive care unit with acute heart failure. AU - Valle,Roberto, AU - Aspromonte,Nadia, AU - Giovinazzo,Prospero, AU - Carbonieri,Emanuele, AU - Chiatto,Mario, AU - di Tano,Giuseppe, AU - Feola,Mauro, AU - Milli,Massimo, AU - Fontebasso,Alessandra, AU - Barro,Sabrina, AU - Bardellotto,Stefania, AU - Milani,Loredano, PY - 2007/06/17/received PY - 2007/09/30/revised PY - 2007/10/10/accepted PY - 2008/4/3/pubmed PY - 2008/5/13/medline PY - 2008/4/3/entrez SP - 219 EP - 24 JF - Journal of cardiac failure JO - J Card Fail VL - 14 IS - 3 N2 - BACKGROUND: Studies with natriuretic peptides have suggested that physicians do not treat heart acute failure (AHF) aggressively enough, and predischarge B-type natriuretic peptide (BNP) levels may be a useful reminder that more treatment is required. The purpose of this study was to demonstrate that variations in BNP levels during hormone-guided treatment and measured body hydration status enable the timing of the patient's discharge to be optimized. METHODS AND RESULTS: We retrospectively evaluated 186 patients admitted for AHF. All subjects underwent serial bioelectrical impedance analysis and BNP measurement. Therapy was titrated according to BNP value to reach a BNP value of <250 pg/mL, whenever is possible. A BNP value on discharge of <250 pg/mL (obtained in 54% of the patients) predicted a 16% event rate within 6 months, whereas a value >250 pg/mL was associated with a far higher percentage (78%) of adverse events. Among the former, no significant differences in event rate were seen in relation to the time necessary to obtain a reduction in BNP values below 250 pg/mL (14 versus 18%, chi-square = 0.3, NS). Cox regression showed that a BNP cutoff value of 250 pg/mL is the most accurate predictors of events. CONCLUSIONS: Our study demonstrates the usefulness of BNP in intrahospital stratification of AHF, in the decision-making process, and as a tool for "tailored therapy." Integrating this approach into the routine assessment of HF patients would allow clinicians to more accurately identify high-risk patients, who may derive increased benefit from intensive in-hospital management strategies. SN - 1532-8414 UR - https://www.unboundmedicine.com/medline/citation/18381185/B_type_natriuretic_Peptide_guided_treatment_for_predicting_outcome_in_patients_hospitalized_in_sub_intensive_care_unit_with_acute_heart_failure_ DB - PRIME DP - Unbound Medicine ER -