B-Type Natriuretic Peptide Levels and Mortality in Patients With and Without Heart Failure

Background Circulating B-type natriuretic peptide (BNP) concentrations strongly predict mortality in heart failure (HF) patients. Both cardiac and extra-cardiac stimuli influence BNP levels, suggesting that BNP might have similar prognostic value in patients without HF. Objectives To compare the prognostic value of BNP between patients with and without HF. Methods Using the Vanderbilt University Medical Center electronic health record, we studied 30,487 patients (median age 63 years, 50% men, 17% black, 38% HF) who had a first plasma BNP measurement between 2002 and 2013, with follow-up through 2015. The risk of death according to BNP level was quantified using multivariable Cox proportional-hazards. Results BNP levels were lower in non-HF (median 89 pg/ml; [IQR: 34–238]) compared with HF patients (388; [150–940]; p<0.0001). Over 90,898 person-years of follow up, 5,903 (31%) non-HF and 6,181 (53%) HF patients died. In multivariable models including demographic and clinical characteristics, BNP and age were the strongest predictors of death in both HF and non-HF patients. In acute care settings and even among outpatients with modestly elevated BNP, the risk of death according to BNP was similar between patients with and without HF. For instance, a BNP of 400 pg/ml was associated with a 3-year risk of death of 21% (95% CI 20–23%) and 19% (17–20%) in HF and non-HF patients, respectively. Conclusions Among patients without HF, plasma BNP level is a stronger predictor of death than traditional risk factors. The risk of death associated with any given BNP level is similar between patients with and without HF, particularly in the acute care setting.