Brain-Type Natriuretic Peptide and Amino-Terminal Pro–Brain-Type Natriuretic Peptide Discharge Thresholds for Acute Decompensated Heart Failure
Authors: Casey N. McQuade, Craig A. Umscheid
Journal: Annals of Internal Medicine (2017)

Letters20 June 2017Brain-Type Natriuretic Peptide and Amino-Terminal Pro–Brain-Type Natriuretic Peptide Discharge Thresholds for Acute Decompensated Heart FailureCasey N. McQuade, MD and Craig A. Umscheid, MD, MSCECasey N. McQuade, MDFrom University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and University of Pennsylvania, Philadelphia, Pennsylvania. and Craig A. Umscheid, MD, MSCEFrom University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and University of Pennsylvania, Philadelphia, Pennsylvania.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0194 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Nusbaum raises an important point about the association between hospital length of stay and readmission rates for patients admitted with acute decompensated heart failure and how this association may have affected our results. In our review, 4 studies adjusted for length of stay in their multivariable analyses (Appendix Table 2 of our article). The association between achieving goal NP levels at discharge and improved readmission and mortality measures was stable despite these adjustments. Results ranged from a hazard ratio of 0.12 (95% CI, 0.02 to 0.72) for mortality to 0.25 (CI, 0.09 to 0.69) and 0.43 (CI, ...References1. Cournot M, Leprince P, Destrac S, Ferrières J. Usefulness of in-hospital change in B-type natriuretic peptide levels in predicting long-term outcome in elderly patients admitted for decompensated heart failure. Am J Geriatr Cardiol. 2007;16:8-14. [PMID: 17215637] CrossrefMedlineGoogle Scholar2. Michtalik HJ, Yeh HC, Campbell CY, Haq N, Park H, Clarke W, et al. Acute changes in N-terminal pro–B-type natriuretic peptide during hospitalization and risk of readmission and mortality in patients with heart failure. Am J Cardiol. 2011;107:1191-5. [PMID: 21296322] doi:10.1016/j.amjcard.2010.12.018 CrossrefMedlineGoogle Scholar3. Valle R, Aspromonte N, Milani L, Peacock FW, Maisel AS, Santini M, et al. Optimizing fluid management in patients with acute decompensated heart failure (ADHF): the emerging role of combined measurement of body hydration status and brain natriuretic peptide (BNP) levels. Heart Fail Rev. 2011;16:519-29. [PMID: 21604179] doi:10.1007/s10741-011-9244-4 CrossrefMedlineGoogle Scholar4. Shah MR, Hasselblad V, Tasissa G, Christenson RH, Binanay C, O'Connor CM, et al. Rapid assay brain natriuretic peptide and troponin I in patients hospitalized with decompensated heart failure (from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness Trial). Am J Cardiol. 2007;100:1427-33. [PMID: 17950802] CrossrefMedlineGoogle Scholar5. Bettencourt P, Azevedo A, Pimenta J, Friões F, Ferreira S, Ferreira A. N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. Circulation. 2004;110:2168-74. [PMID: 15451800] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and University of Pennsylvania, Philadelphia, Pennsylvania.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1468. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBrain-Type Natriuretic Peptide and Amino-Terminal Pro–Brain-Type Natriuretic Peptide Discharge Thresholds for Acute Decompensated Heart Failure Casey N. McQuade , Marisa Mizus , Joyce W. Wald , Lee Goldberg , Mariell Jessup , and Craig A. Umscheid Brain-Type Natriuretic Peptide and Amino-Terminal Pro–Brain-Type Natriuretic Peptide Discharge Thresholds for Acute Decompensated Heart Failure Neil J. Nusbaum Metrics Cited byTrends in Characteristics and Outcomes in Primary Heart Failure Hospitalizations Among Older Population in the United States, 2004 to 2018 20 June 2017Volume 166, Issue 12Page: 916KeywordsDisclosureHazard ratioHeart failureLength of stayMortalityNatriuretic peptides ePublished: 20 June 2017 Issue Published: 20 June 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...