Clinical profile and prognostic significance of natriuretic peptide trajectory following hospitalization for worsening chronic heart failure: findings from the ASTRONAUT trial

• Published in: European journal of heart failure Vol. 17; no. 1; pp. 98 - 108
• Main Authors: Greene, Stephen J., Maggioni, Aldo P., Fonarow, Gregg C., Solomon, Scott D., Böhm, Michael, Kandra, Albert, Prescott, Margaret F., Reimund, Bernard, Hua, Tsushung A., Lesogor, Anastasia, Zannad, Faiez, Gheorghiade, Mihai
• Format: Journal Article
• Language: English
• Published: Oxford, UK John Wiley & Sons, Ltd 01-01-2015; European Society of Cardiology (Wiley)
• Subjects: Aged; Amides; Amides - therapeutic use; Cardiology and cardiovascular system; Chronic Disease; Cohort Studies; Disease Progression; Female; Fumarates; Fumarates - therapeutic use; Heart Failure; Heart Failure - blood; Heart Failure - drug therapy; Heart Failure - mortality; Hospitalization; Human health and pathology; Humans; Life Sciences; Male; Middle Aged; Natriuretic Peptide, Brain; Natriuretic Peptide, Brain - blood; Natriuretic Peptides; Outcomes; Peptide Fragments; Peptide Fragments - blood; Prognosis; Proportional Hazards Models; Renin; Renin - antagonists & inhibitors; Heart Failure; Natriuretic Peptides; Hospitalization; Outcomes
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1002/ejhf.201

Aims
The purpose of this study was to determine the prognostic significance and associated clinical profile of early post‐discharge N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) trajectory among patients hospitalized for worsening chronic heart failure (HHF).
Methods and results
This post‐hoc analysis of the Aliskiren Trial in Acute Heart Failure Outcomes (ASTRONAUT) included 1351 HHF patients with ejection fraction (EF) ≤40%, elevated B‐type natriuretic peptide ≥400 pg/mL or NT‐proBNP ≥1600 pg/mL at admission, and available NT‐proBNP measurements (from a central core laboratory) at baseline (median 5 days after admission) and 1‐month follow‐up. The co‐primary endpoints were all‐cause mortality and cardiovascular mortality or HHF within 12 months. Median follow‐up was 11.3 months. Patients with decreasing post‐discharge NT‐proBNP trajectory tended to be younger and have non‐ischaemic HF aetiology. The presence of baseline atrial fibrillation was associated with high NT‐proBNP at 1 month (i.e. above the median), regardless of the baseline value. After adjustment for patient characteristics and 1‐month NT‐proBNP level, every twofold increase in continuous NT‐proBNP change from baseline to 1 month was predictive of increased cardiovascular mortality or HHF (hazard ratio 1.14; 95% confidence interval 1.02–1.26), but not all‐cause mortality (hazard ratio 0.95; 95% confidence interval 0.81–1.11).
Conclusion
In this cohort of HHF patients with reduced EF, early post‐discharge NT‐proBNP trajectory was associated with a distinct clinical profile and carried independent prognostic value after adjustment for patient characteristics and absolute NT‐proBNP level. Future prospective study of serial NT‐proBNP measurement during the hospital and early post‐discharge periods is warranted to validate these findings and evaluate post‐discharge NT‐proBNP trajectory as a therapeutic target.