Post-discharge changes in NT-proBNP and quality of life after acute dyspnea hospitalization as predictors of one-year outcomes

Aims: The association of serial NT-proBNP changes and poor quality of life (QOL) with progressive heart failure (HF) and clinical outcomes in emergency department dyspnea patients is poorly understood. Methods and results: The predictive value of changes in NT-proBNP and QOL (Minnesota Living with Heart Failure scale) from baseline to 30-day follow-up was examined for all-cause 1-year mortality and HF hospitalization. Patients with an initially elevated NT-proBNP (>= 300 ng/L) which persisted at 30-days (no >= 25% decrease) were at high risk of death or HF hospitalization (HR=6.36, 95%CI=3.04-13.28). Combined with sustained poor QOL, these subjects with persistently elevated NT-proBNP were at highest mortality risk or HF hospitalization (HR = 8.75, 95%CI=3.62-21.16). Conclusions: Dyspnea patients with elevated NT-proBNP concentrations and no improvement in either NT-proBNP or QOL at 30-days are at high risk of mortality and HF hospitalization. These data highlight the value of serial biomarker measurements combined with serial evaluations for QOL. (C) 2010 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.