What question did this study set out to answer?

To develop a prognostic risk score incorporating clinical comorbidities, NYHA classification, and NT-proBNP levels to predict two-year outcomes in patients with chronic heart failure.

March 26, 2019PLoS ONEOpen Access

Prognostic value of NT-proBNP added to clinical parameters to predict two-year prognosis of chronic heart failure patients with mid-range and reduced ejection fraction – A report from FAR NHL prospective registry

Q: What are the key findings of this study?

Adding NT-proBNP to a clinical model improved the prediction of two-year all-cause mortality, heart transplantation, or LVAD implantation in chronic heart failure patients (AUC 0.773 to 0.790).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic heart failure with mid-range and reduced ejection fraction (n=1088). Intervention: NT-proBNP addition to clinical parameters vs. Clinical parameters alone. Primary outcome: Two-year all-cause mortality, heart transplantation and/or LVAD implantation (AUC 0.790, p=<0.001).

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Key result

Adding NT-proBNP improves clinical model prediction of two-year mortality, transplant, or LVAD in chronic HF.

AUC 0.790
P<0.001
n=1,088

Why the study?

Guidelines recommend predicting chronic heart failure prognosis using natriuretic peptides, NYHA classification, and comorbidities, prompting the development of a prognostic score integrating these factors.

Does adding NT-proBNP to clinical parameters improve the prediction of two-year mortality, heart transplantation, or LVAD implantation in patients with HFrEF and HFmrEF?

Population

1,088 chronic heart failure patients with HFrEF (LVEF<40%) and HFmrEF (LVEF 40-49%)

Comparison

Clinical model with added NT-proBNP level vs clinical model alone

Design

Prospective registry study

Follow-up

Two-year

Authors

JŠJindřich ŠpinarLaboratoire Lorrain de Recherche en Informatique et ses Applications LŠLenka ŠpinarováDorset HealthCare University NHS Foundation Trust FMFilip MálekSemmelweis University

Discussion

Member takes

Implication

May refine risk estimates in HFrEF/HFmrEF; leaves open whether integration changes management or outcomes.

Key Points

To develop a prognostic risk score incorporating clinical comorbidities, NYHA classification, and NT-proBNP levels to predict two-year outcomes in patients with chronic heart failure.
Enrolled 1,088 consecutive chronic heart failure patients with reduced (LVEF <40%) or mid-range (LVEF 40–49%) ejection fraction from a prospective registry.
Evaluated a composite primary endpoint comprising two-year all-cause mortality, heart transplantation, or left ventricular assist device (LVAD) implantation.
Assessed discrimination (AUC) for individual markers and a multivariable clinical model before and after the addition of NT-proBNP levels.
The primary endpoint occurred in 14.9% of patients overall, increasing with NYHA class (4.9% in class I, 11.4% in class II, and 27.8% in class III–IV; p < 0.001) and NT-proBNP level (3% for ≤125 ng/L, 10% for 126–1000 ng/L, and 15–37% for >1000 ng/L).
Individual discriminatory performance yielded an AUC of 0.670 (p < 0.001) for NYHA classification and an AUC of 0.722 (p < 0.001) for NT-proBNP.
A baseline clinical model incorporating older age, advanced NYHA class, anaemia, hyponatraemia, hyperuricaemia, and high furosemide dose achieved an AUC of 0.773 (p < 0.001), which improved to an AUC of 0.790 upon adding NT-proBNP.

Study Design

Type

Cohort (n=1,088)

Structured PICO

Does adding NT-proBNP to clinical parameters improve the prediction of two-year mortality, heart transplantation, or LVAD implantation in patients with HFrEF and HFmrEF?

Population

1,088 patients with chronic heart failure with reduced ejection fraction (HFrEF) (LVEF<40%) and mid-range EF (HFmrEF) (LVEF 40-49%)

Intervention

Prognostic score including NT-proBNP levels added to clinical parameters (older age, advanced heart failure (NYHA III+IV), anaemia, hyponatraemia, hyperuricaemia, and furosemide >40 mg daily)

Comparator

Clinical parameters alone

Outcome

Composite of two-year all-cause mortality, heart transplantation and/or LVAD implantationcomposite

Main Result

Effect estimate: AUC 0.790

p-value: p=<0.001

Adding NT-proBNP to a clinical prediction model improves prognostic accuracy for 2-year adverse outcomes in patients with HFrEF and HFmrEF.

Cite This Study

Špinar et al. (2019) conducted a cohort in Chronic heart failure with mid-range and reduced ejection fraction (n=1,088). NT-proBNP addition to clinical parameters vs. Clinical parameters alone was evaluated on Two-year all-cause mortality, heart transplantation and/or LVAD implantation (AUC 0.790, p=<0.001). Adding NT-proBNP to a clinical model improved the prediction of two-year all-cause mortality, heart transplantation, or LVAD implantation in chronic heart failure patients (AUC 0.773 to 0.790).

synapsesocial.com/papers/6a0d8d146e03bc61cb09ce57 https://doi.org/10.1371/journal.pone.0214363

Topics

HFrEF treatment Heart transplantation Heart failure HFpEF management

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March 26, 2019PLoS ONEOpen Access

Prognostic value of NT-proBNP added to clinical parameters to predict two-year prognosis of chronic heart failure patients with mid-range and reduced ejection fraction – A report from FAR NHL prospective registry

View Full Paper

Ask AI

Bookmark

Key result

Adding NT-proBNP improves clinical model prediction of two-year mortality, transplant, or LVAD in chronic HF.

AUC 0.790
P<0.001
n=1,088

Why the study?

Does adding NT-proBNP to clinical parameters improve the prediction of two-year mortality, heart transplantation, or LVAD implantation in patients with HFrEF and HFmrEF?

Population

1,088 chronic heart failure patients with HFrEF (LVEF<40%) and HFmrEF (LVEF 40-49%)

Comparison

Clinical model with added NT-proBNP level vs clinical model alone

Design

Prospective registry study

Follow-up

Two-year

Authors

JŠJindřich ŠpinarLaboratoire Lorrain de Recherche en Informatique et ses Applications LŠLenka ŠpinarováDorset HealthCare University NHS Foundation Trust FMFilip MálekSemmelweis University

Discussion

Member takes

Implication

May refine risk estimates in HFrEF/HFmrEF; leaves open whether integration changes management or outcomes.

Key Points

To develop a prognostic risk score incorporating clinical comorbidities, NYHA classification, and NT-proBNP levels to predict two-year outcomes in patients with chronic heart failure.
Enrolled 1,088 consecutive chronic heart failure patients with reduced (LVEF <40%) or mid-range (LVEF 40–49%) ejection fraction from a prospective registry.
Evaluated a composite primary endpoint comprising two-year all-cause mortality, heart transplantation, or left ventricular assist device (LVAD) implantation.
Assessed discrimination (AUC) for individual markers and a multivariable clinical model before and after the addition of NT-proBNP levels.
The primary endpoint occurred in 14.9% of patients overall, increasing with NYHA class (4.9% in class I, 11.4% in class II, and 27.8% in class III–IV; p < 0.001) and NT-proBNP level (3% for ≤125 ng/L, 10% for 126–1000 ng/L, and 15–37% for >1000 ng/L).
Individual discriminatory performance yielded an AUC of 0.670 (p < 0.001) for NYHA classification and an AUC of 0.722 (p < 0.001) for NT-proBNP.
A baseline clinical model incorporating older age, advanced NYHA class, anaemia, hyponatraemia, hyperuricaemia, and high furosemide dose achieved an AUC of 0.773 (p < 0.001), which improved to an AUC of 0.790 upon adding NT-proBNP.

Study Design

Type

Cohort (n=1,088)

Structured PICO

Does adding NT-proBNP to clinical parameters improve the prediction of two-year mortality, heart transplantation, or LVAD implantation in patients with HFrEF and HFmrEF?

Population

1,088 patients with chronic heart failure with reduced ejection fraction (HFrEF) (LVEF<40%) and mid-range EF (HFmrEF) (LVEF 40-49%)

Intervention

Prognostic score including NT-proBNP levels added to clinical parameters (older age, advanced heart failure (NYHA III+IV), anaemia, hyponatraemia, hyperuricaemia, and furosemide >40 mg daily)

Comparator

Clinical parameters alone

Outcome

Composite of two-year all-cause mortality, heart transplantation and/or LVAD implantationcomposite

Main Result

Effect estimate: AUC 0.790

p-value: p=<0.001

Adding NT-proBNP to a clinical prediction model improves prognostic accuracy for 2-year adverse outcomes in patients with HFrEF and HFmrEF.

Cite This Study

synapsesocial.com/papers/6a0d8d146e03bc61cb09ce57 https://doi.org/10.1371/journal.pone.0214363

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

Topics

HFrEF treatment Heart transplantation Heart failure HFpEF management

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