Abstract 11852: Prognostic Value of B-type Natriuretic Peptide Reduction and Uric Acid Levels as Predictors of 30-day Re-Admission in Patients With Acute Decompensated Heart Failure With Preserved Ejection Fraction

Abstract

Introduction: There is limited data comparing re-admission outcomes in patients with heart failure with preserved ejection fraction (HFpEF). This study aimed to determine the prognostic value of B-natriuretic peptide (BNP) level reduction and uric acid levels in hospitalized HFpEF patients. Hypothesis: Higher BNP level reduction and uric acid levels are associated with higher 30-day re-admission rates. Methods: This was a multi-center retrospective analysis of 3,398 patients admitted with acute decompensated HFpEF from January 2017 to December 2019. HFpEF was defined as a left ventricular function ≥ 50% and at least stage I diastolic dysfunction. Outcomes were defined by 30-day re-hospitalization rates for the two groups in the inpatient setting. Baseline characteristics, cardiovascular risk factors, admission laboratory data (troponin, sodium, hemoglobin A1c, uric acid), vital signs, length of stay and time to readmission due to heart failure exacerbation were gathered and compared. Results: The median age was 75.5 years and the mean length of stay was 11.1 days. The mean BNP at admission was 910 and the second BNP following standard therapy was 786. The median percent change in BNP was found to be 16.95%. Of the hypothesized clinical predictors of re-admission, we found that none of them; including change in BNP reduction and uric acid, were predictive of re-admission. Those who were re-admitted had lower sodium levels (136.6±5.86 vs 137.0±6.07, p=0.06), while improved creatinine levels (1.94±1.31 vs 2.06±1.66, p=0.02) was associated with re-admission for unclear reasons. For those patients who are white, the odds of experiencing re-admission is 1.54 times more likely compares to those who are of other race. Conclusions: Lower sodium levels and lower creatinine levels were found to be important risk factors for readmission. None of the hypothesized clinical variables including BNP reduction and uric acid predicted re-admission except for white race, which we feel is a surrogate for socioeconomic status. These findings underline the need for further studies and complexity in planning re-admission prevention algorithms in HFpEF patients.