Abstract
BackgroundReal‐world data on the clinical outcomes of heart failure (HF) across the spectrum of ejection fraction (EF) and the prognostic value of B‐type natriuretic peptide (BNP) have not been well examined.HypothesisThe real‐world association between the clinical outcomes of HF and EF or BNP levels may differ across different EF or BNP values.MethodsThe Optum Integrated Claims‐Clinical data (07/2009‐09/2016) was used to identify adult patients with ≥1 HF diagnosis during hospitalization or emergency room visit. Three EF cohorts were formed: reduced (rEF; EF < 40%), mid‐range (mrEF; EF 40%‐49%), and preserved EF (pEF; EF ≥ 50%). Stratifications by BNP levels were performed using median BNP as cutoff between high vs low BNP (H‐BNP vs L‐BNP).ResultsIn total, 7005 HF patients with EF measurements (2456 patients with both HF and BNP measurements) were identified. rEF patients had higher risk of stroke (hazard ratio [HR] = 1.57, P = 0.010) and acute myocardial infarction (AMI) (HR = 2.42, P < 0.001) compared to pEF patients. H‐BNP was associated with a significantly higher risk of mortality (P < 0.001). rEF patients with H‐BNP had a significantly higher risk of stroke than those with L‐BNP.ConclusionsPatients with rEF had a significantly higher rate of stroke and AMI vs pEF patients, as did patients with H‐BNP vs L‐BNP. The present study is the first to show the real‐world association of EF and BNP (alone and in combination) with clinical outcomes, further supporting the recommendation to use these markers in clinical practice. These results may help to guide future recommendations and improve the clinical management of HF.
Highlights
Heart failure (HF) manifests when the heart's capacity to sustain blood flow is compromised, resulting in shortness of breath, fatigue, and systemic and pulmonary congestion.[1,2] In 2016, 5.7 million (2.2%) individuals had heart failure (HF) in the United States.[3,4] The burden of this disease is substantial, and approximately half of patients with HF die from complications ensuing from HF within 5 years following initial diagnosis.[4]
Comparing stroke and acute myocardial infarction (AMI) risk across all ejection fraction (EF) cohorts among patients diagnosed with diabetes or coronary artery disease (CAD) revealed trends that were very similar to those observed in the overall HF population, suggesting that conclusions on the prognostic value of EF hold true for these patients
The prognostic value of EF and B-type natriuretic peptide (BNP) levels among HF patients remains understudied in the real world
Summary
Real-world data on the clinical outcomes of heart failure (HF) across the spectrum of ejection fraction (EF) and the prognostic value of B-type natriuretic peptide (BNP) have not been well examined. REF patients had higher risk of stroke (hazard ratio [HR] = 1.57, P = 0.010) and acute myocardial infarction (AMI) (HR = 2.42, P < 0.001) compared to pEF patients. The present study is the first to show the real-world association of EF and BNP (alone and in combination) with clinical outcomes, further supporting the recommendation to use these markers in clinical practice. These results may help to guide future recommendations and improve the clinical management of HF. KEYWORDS B-type natriuretic peptide, ejection fraction, heart failure, myocardial infarction, real-world, stroke
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