Clinical Status and B-Type Natriuretic Peptide Levels in Patients with Heart Failure at Hospital Discharge

Abstract

Levels of natriuretic peptides and their changes in the course of therapy may serve as a prognostic marker of long-term survival in patients with heart failure. The authors compared natriuretic peptide levels in patients with heart failure at admission and at hospital discharge and examined the relationship between their natriuretic peptide levels and clinical status at hospital discharge. 108 patients with acute heart failure underwent, at admission to hospital and discharge after clinical improvement, an examination consisting of a physical checkup, B-type natriuretic peptide (BNP) measurements, and echocardiography. In addition, each patient was asked to use a 1-100 graphic grading scale to indicate a level of satisfaction with his/her overall health status, as well as quality of breathing at admission and discharge. All patients had elevated BNP levels at admission (1,066 +/- 887.8 pg/ml). In the course of treatment, all patients demonstrated a statistically significant downward trend in BNP levels (p < 0.002). However, BNP levels at discharge still remained in the pathologic range. Both at admission and discharge, patients with left ventricular systolic dysfunction had BNP values statistically significantly higher than those with diastolic dysfunction (1,880 +/- 1,160 vs. 454 +/- 323 pg/ml, and 993 +/- 828 vs. 338 +/- 226 pg/ml, respectively). Patients with repeated attacks of heart failure prior to admission had higher BNP levels compared to those with a first attack (p < 0.001). Both groups showed a statistically significant difference in subjective perception of difficulties which, both at admission and discharge, was reported by patients with a first decompensation attack as being more marked (p < 0.002 and p < 0.009, respectively). The question arises, whether one's "objective" assessment of the final degree of compensation at discharge may or may not be premature, and whether a follow-up "prognostic" BNP determination should or should not be performed until the moment of a "subjective optimum" as reported by the patient.