B-type natriuretic peptide level and postdischarge thrombotic events in older patients hospitalized with heart failure: Insights from the Acute Decompensated Heart Failure National Registry
American Heart Journal,

Kociol RD et al. – Higher B–type natriuretic peptide (BNP) level upon admission with heart failure (HF) among older patients without atrial fibrillation (AF) was associated with increased risks of myocardial infarction (MI) and mortality; however, higher BNP level was not associated with subsequent thromboembolism or stroke.

Methods
  • Authors linked data from the ADHERE registry for 2003 through 2006 with Medicare claims to identify patients ≥65 years who were hospitalized with HF, did not have AF, and did not receive warfarin at discharge.
  • They estimated rates of all–cause mortality, thromboembolic events, myocardial infarction (MI), and stroke using Kaplan–Meier methods and the cumulative incidence function.
  • They used Cox models to assess associations between log BNP level and each outcome after adjustment for potential confounders.

Results
  • The study population included 11,679 patients from 146 sites.
  • Patients in the highest quartile of BNP level were older and more often male and African American.
  • They had higher rates of coronary artery disease, renal insufficiency, and peripheral vascular disease and lower rates of diabetes mellitus and chronic obstructive pulmonary disease.
  • After multivariable adjustment, each 30% increase in BNP level was associated with increased risks of death (hazard ratio 1.07, 95% CI 1.05–1.08) and MI (1.07, 1.04–1.10) but not thromboembolism or stroke.

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