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, 05/14/2012
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.
- 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.