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

Søren L. Kristensen, Pardeep S. Jhund, Lars Køber, Robert S. McKelvie, Michael R. Zile, Inder S. Anand, Michel Komajda, John G F Cleland, Peter E. Carson, John J V McMurray

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14 Scopus citations

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 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.

Original languageEnglish (US)
Pages (from-to)478-486
Number of pages9
JournalJACC: Heart Failure
Volume3
Issue number6
DOIs
StatePublished - Jan 1 2015

Keywords

  • Heart failure
  • Heart failure with preserved ejection fraction
  • NT-proBNP outcomes
  • Prognostic markers

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    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., & 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), 478-486. https://doi.org/10.1016/j.jchf.2015.01.014