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

TY - JOUR

T1 - 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

AU - Kristensen, Søren L

AU - Jhund, Pardeep S

AU - Køber, Lars

AU - McKelvie, Robert S

AU - Zile, Michael R

AU - Anand, Inder S

AU - Komajda, Michel

AU - Cleland, John G F

AU - Carson, Peter E

AU - McMurray, John J V

N1 - Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - 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 andNT-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 forcardiovascular events, and this risk was increased further when both factors were present.

AB - 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 andNT-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 forcardiovascular events, and this risk was increased further when both factors were present.

KW - Aged

KW - Female

KW - Heart Failure

KW - Hospitalization

KW - Humans

KW - Male

KW - Natriuretic Peptide, Brain

KW - Peptide Fragments

KW - Predictive Value of Tests

KW - Proportional Hazards Models

KW - Risk Factors

KW - Stroke Volume

U2 - 10.1016/j.jchf.2015.01.014

DO - 10.1016/j.jchf.2015.01.014

M3 - Journal article

C2 - 26046842

SN - 2213-1779

VL - 3

SP - 478

EP - 486

JO - J A C C: Heart Failure

JF - J A C C: Heart Failure

IS - 6

ER -