What does this research mean for the field?

B-type natriuretic peptide and urinary albumin-to-creatinine ratio are key independent risk factors for new-onset heart failure that provide incremental predictive utility over standard risk factors in a community setting. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate whether a parsimonious panel of biomarkers reflecting key biological pathways improves the prediction of incident heart failure beyond standard clinical risk factors.

October 12, 2010CirculationOpen Access

Multimarker Approach for the Prediction of Heart Failure Incidence in the Community

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Why the study?

There are no data on the incremental utility of a parsimonious set of biomarkers for predicting heart failure risk in the community.

Does a multibiomarker panel improve the prediction of incident heart failure in a community-based population free of heart failure?

Key Points

To evaluate whether a parsimonious panel of biomarkers reflecting key biological pathways improves the prediction of incident heart failure beyond standard clinical risk factors.
Prospective cohort analysis of 2754 Framingham Heart Study participants (mean age 58 years; 54% women) free of heart failure at baseline, followed for a mean of 9.4 years.
Measured six circulating biomarkers: C-reactive protein, plasminogen activator inhibitor-1, homocysteine, aldosterone-to-renin ratio, B-type natriuretic peptide, and urinary albumin-to-creatinine ratio.
Assessed predictive utility using multivariable-adjusted models, backward elimination, model c-statistic, calibration, and net reclassification improvement.
During follow-up, 95 first heart failure events occurred (54 in men), with the overall multibiomarker panel significantly associating with heart failure risk (P=0.00005).
B-type natriuretic peptide (HR 1.52 per 1-SD increment, 95% CI 1.24 to 1.87) and urinary albumin-to-creatinine ratio (HR 1.35 per 1-SD increment, 95% CI 1.11 to 1.66) emerged as the primary independent predictors.
Adding both biomarkers increased the model c-statistic from 0.84 (95% CI 0.80 to 0.88) to 0.86 (95% CI 0.83 to 0.90) and achieved significant risk reclassification (net reclassification improvement = 0.13; P=0.002).

Structured PICO

Does a multibiomarker panel improve the prediction of incident heart failure in a community-based population free of heart failure?

Population

2754 Framingham Heart Study participants free of heart failure (mean age, 58 years; 54 women)

Intervention

Multibiomarker panel (C-reactive protein, plasminogen activator inhibitor-1, homocysteine, aldosterone-to-renin ratio, B-type natriuretic peptide, and urinary albumin-to-creatinine ratio)

Comparator

Standard risk factor models

Outcome

Incidence of a first heart failure eventhard clinical

The addition of B-type natriuretic peptide and urinary albumin-to-creatinine ratio to standard risk factors provides incremental predictive utility for identifying individuals at risk for new-onset heart failure in the community.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

May aid community HF risk stratification; hypothesis-generating and requires prospective validation before practice change.

Cite This Study

Velagaleti et al. (2010) studied this question.

synapsesocial.com/papers/6a1bc57527b545b111a8fc0b https://doi.org/10.1161/circulationaha.109.929661

Topics

Heart failure HFrEF treatment

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Multimarker Approach for the Prediction of Heart Failure Incidence in the Community

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Multimarker Approach for the Prediction of Heart Failure Incidence in the Community

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider