Elevated NT-proBNP levels were independently associated with increased all-cause mortality (HR 1.377) and significantly improved prognostic evaluation when added to CHADS2 and CHA2DS2VASc scores.
Cohort (n=219)
No
Do NT-proBNP levels improve the prognostic evaluation of all-cause mortality compared to CHADS2 and CHA2DS2-VASc scores in older Chinese patients with atrial fibrillation?
In older Chinese patients with atrial fibrillation, NT-proBNP levels provide independent and incremental prognostic value for all-cause mortality beyond traditional CHADS2 and CHA2DS2-VASc scores.
Hazard Ratio: 1.377 (95% CI 1.063–1.785)
p-value: p=<0.05
Atrial fibrillation (AF) is the most common arrhythmia and has increased prevalence in older patients, leading to poor prognosis for these patients. There is a need for a biomarker or a model of prognostic evaluation in older patients with AF, especially in China. CHADS 2 and CHA 2 DS 2 VASc scores have been applied to evaluate their prognosis in patients with AF. This analysis was designed to examine whether N-terminal pro-brain natriuretic peptide (NT-proBNP) levels significantly improved the evaluation of all-cause mortality in older Chinese patients with AF when added to CHADS 2 and CHA 2 DS 2 VASc scores. There were 219 older patients with AF, and follow-up was 100% complete over an average of 1.11 years. Cox regression analysis was applied to determine the variables independently associated with all-cause mortality. Median age was 85 years, and all-cause mortality was 24.2% (53 patients). Plasma NT-proBNP levels were significantly associated with all-cause mortality in univariate hazard ratio (HR): 1.842; 95% confidence interval (CI): 1.530–2.218 and multivariate (HR: 1.377; 95% CI: 1.063–1.785) Cox regression analyses and had significantly higher c-statistic (0.771; 95% CI: 0.698–0.845) than CHADS 2 (0.639; 95% CI: 0.552–0.726) and CHA 2 DS 2 VASc (0.633; 95% CI: 0.546–0.720) scores ( P < 0.05 for all). The addition of NT-proBNP levels to CHADS 2 (0.783; 95% CI: 0.713–0.854) and CHA 2 DS 2 VASc (0.775; 95% CI: 0.704–0.846) scores significantly increased their c-statistics ( P < 0.001 for all). Model based on NT-proBNP levels including age, hemoglobin, fasting blood glucose, glomerular filtration rate and NT-proBNP levels had a significantly higher c-statistic (0.890; 95% CI: 0.841–0.938) than CHADS 2 and CHA 2 DS 2 VASc scores (P < 0.001 for all). Model based on NT-proBNP levels had significantly higher c-statistic than the addition of NT-proBNP levels to CHADS 2 and CHA 2 DS 2 VASc scores ( P < 0.05). NT-proBNP levels were an independent biomarker associated with an increased all-cause mortality in older Chinese patients with AF, and had an independent and added ability to evaluate their all-cause mortality compared with CHADS 2 and CHA 2 DS 2 VASc scores.
Fu et al. (2019) conducted a cohort in Atrial fibrillation (n=219). N-terminal pro-brain natriuretic peptide (NT-proBNP) levels vs. CHADS2 and CHA2DS2VASc scores was evaluated on All-cause mortality (HR 1.377, 95% CI 1.063-1.785, p=<0.05). Elevated NT-proBNP levels were independently associated with increased all-cause mortality (HR 1.377) and significantly improved prognostic evaluation when added to CHADS2 and CHA2DS2VASc scores.