The prognostic value of B-type natriuretic peptides in chronic heart failure patients - A primary care perspective
Managing chronic heart failure in primary care is challenging due to an older patient population who suffers from multiple comorbidities and takes several medication daily. The high rates of re-admission to hospital, as well as the cost of care continue to be a financial burden. B-type natriuretic peptides are important cardiac biomarkers that can be measured with an inexpensive blood test and can guide the effective management of heart failure patients by primary care physicians.
A retrospective cohort study in chronic heart failure outpatients was conducted in order to investigate the prognostic utility of B-type natriuretic peptides in the primary care setting. The data source consisted of electronic medical records from the Clinical Practice Research Datalink with a study period between January 1st, 2005 and September 30th, 2012. The cohort had a variable entry defined as the date of the date of first B-type natriuretic peptide measurement, while the exit from the cohort was either the event of death or the end of study period. There were no restrictions on the duration of the follow-up period, thus all data available within the study period was included.
B-type natriuretic peptides such as BNP and NTproBNP were associated with the all-cause mortality, as well with the cardiovascular mortality, independently of age, gender, body mass index, smoking status, geographic region, serum creatinine, diabetes, hypertension and heart failure medication. For all-cause mortality, the logeBNP and logeNTproBNP unadjusted hazard ratios were 1.37 (95%CI: 1.23, 1.41) and 1.37 (95% CI: 1.30, 1.43), respectively. For the cardiovascular mortality, the logeBNP and logeNTproBNP unadjusted hazard ratios were 1.41 (95% CI: 1.29, 1.55) and 1.39 (95%CI: 1.29, 1.49), respectively. The mean B-type natriuretic peptide levels were higher in male, underweight outpatients over 75 years old.
In the primary care setting, single B-type natriuretic peptides predict mortality. Monitoring B-type natriuretic levels can optimize the management of chronic heart failure patients.
- Milena Kurtinecz
- Richard Hobbs
- Rafael Perera