Abstract
Background. The COVID-19 pandemic has had a deep impact on periodic outpatient evaluations. The aim of this study was to evaluate the impact of low brain natriuretic peptide (BNP) values in predicting adverse events in heart failure (HF) patients in order to evaluate implications for safe delay of outpatient visits. Methods. This was a retrospective study. One-thousand patients (mean age: 72 ± 10 years, 561 women) with HF and BNP values <250 pg/mL at discharge were included. A 6-month follow-up was performed. The primary endpoint was a combination of deaths and readmissions for HF within 6-month after discharge. Results. At 6-month follow-up, 104 events (10.4%) were recorded (65 HF readmissions and 39 all-cause deaths). Univariate Cox analysis identified as significant predictors of outcome were age (p < 0.001, hazard ratio [HR] = 1.044), creatinine (p = 0.001, HR = 1.411), and BNP (p < 0.001, HR = 1.010). Multivariate Cox regression confirmed that BNP (p < 0.001, HR = 1.009), creatinine (p = 0.016, HR = 1.247), and age (p = 0.013, HR = 1.027) were independent predictors of events in HF patients with BNP values <250 pg/mL at discharge. Patients with BNP values >100 pg/mL and creatinine >1.0 mg/dL showed increased events rates (from 4.3% to 19.0%) as compared to those with lower values (p < 0.000, HR = 4.014). Conclusions. Low pre-discharge BNP levels were associated with low rates of cardiovascular events in HF patients, independently of the frequency of follow-up.
Highlights
Since the beginning of 2020, coronavirus disease (COVID)-19 has spread worldwide, affecting the cardiovascular system both directly and indirectly [1,2] and forcing the rapid and radical transformation of our health systems during the last year
Patients not affected by COVID-19 are facing too many difficulties in terms of the management of both acute emergencies and chronic conditions such as heart failure (HF) [3]
HF was defined as follows: (1) symptoms of HF according to the criteria commonly accepted in the literature [8], namely the presence of two major criteria or one major criterion plus two minor criteria according to the Framingham score; (2) exacerbation of HF symptoms with at least one NYHA class deterioration; (3) evidence of left ventricular systolic and/or diastolic dysfunction at echocardiographic examination; (4) brain natriuretic peptide (BNP) levels > 100 pg/mL on admission
Summary
Since the beginning of 2020, coronavirus disease (COVID)-19 has spread worldwide, affecting the cardiovascular system both directly and indirectly [1,2] and forcing the rapid and radical transformation of our health systems during the last year. There are still many concerns about the risk of re-opening while the disease is still being transmitted. During this period, the general attitude has been to prioritize caring for COVID-19 patients with critical and time-sensitive clinical presentation. Patients not affected by COVID-19 are facing too many difficulties in terms of the management of both acute emergencies and chronic conditions such as heart failure (HF) [3]. Innovative approaches should be managed to ensure access to medical care, avoiding risk of exposure. The COVID-19 pandemic reveals the need for more accurate diagnostic information able to provide better health decisions in order to avoid unnecessary access to Emergency
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