What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with reduced ejection fraction (HFrEF) (n=21445). Intervention: Elevated admission NT-proBNP levels (>10,500 pg/ml) vs. Lower admission NT-proBNP levels (<1,669 pg/ml). Primary outcome: 60-day all-cause readmission (adjusted OR 1.116, p=0.013).

June 30, 2021HCA Healthcare Journal of Medicine5 citationsOpen Access

A Retrospective Study of Admission NT-proBNP Levels as a Predictor of Readmission Rate, Length of Stay and Mortality

Q: What are the key findings of this study?

Elevated admission NT-proBNP levels (>10,500 pg/ml) were associated with a significantly higher 60-day all-cause readmission rate compared to levels <1,669 pg/ml (adjusted OR 1.116, p=0.013).

KUKunjan Udani DPDveet Patel AMAndrew Mangano

Key Result

Elevated admission NT-proBNP levels (>10,500 pg/ml) were associated with a significantly higher 60-day all-cause readmission rate compared to levels <1,669 pg/ml (adjusted OR 1.116, p=0.013).

Study Design

Type

Cohort (n=21,445)

Multicenter

Yes

Structured PICO

Does admission NT-proBNP level predict readmission rate, length of stay, and mortality in adult patients admitted with HFrEF?

Population

21,445 adults aged 18 to 75 years admitted for heart failure with reduced ejection fraction, excluding those on dialysis, evaluated for readmission, length of stay, and mortality based on admission NT-proBNP levels.

Exposure

Admission NT-proBNP levels stratified into quartiles: group 1 (<1,669 pg/ml), group 2 (1,670-4,274 pg/ml), group 3 (4,275-10,499 pg/ml), and group 4 (>10,500 pg/ml)

Comparator

Lower quartiles of admission NT-proBNP (e.g., group 1 with NT-proBNP <1,669 pg/ml)

Outcome

30-, 60- and 90-day all-cause readmissions, length of stay (LOS), and in-hospital mortality ratehard clinical

Higher admission NT-proBNP levels in patients with HFrEF are significantly associated with increased 60-day all-cause readmission, longer length of stay, and higher in-hospital mortality.

Main Result

Odds Ratio: 1.116

Absolute Event Rate: 42.8% vs 37.4%

p-value: p=0.013

Limitations

Retrospective design using administrative ICD-10 codes which may have variations in detail and accuracy
NT-proBNP levels can be elevated due to other co-existing conditions (e.g., hypertrophic cardiomyopathy, pulmonary hypertension)
Readmissions to non-HCA Healthcare hospitals were not captured in the dataset
Patients were identified using discharged ICD-10 codes through an electronic administrative database, which may have variations in detail and accuracy.
NT-proBNP levels can be elevated due to other causes such as hypertrophic cardiomyopathy, pericarditis, and pulmonary hypertension.
Patients returning to hospitals outside the HCA Healthcare system would not be included in the readmission data.

Abstract

Introduction: Serum levels of pro-B-type natriuretic peptide (BNP) and N-terminal (NT) proBNP are measured at admission to assess the likelihood of acutely decompensated heart failure (ADHF). Elevated NT-proBNP levels on initial presentation are a reliable marker of ADHF. However, the prognostic significance of NT-proBNP levels measured on admission remains unknown. With a better understanding of how admitting NT-proBNP levels impacts readmission rates, length of stay and mortality, future prospective studies with specific interventions can be developed to reduce all-cause readmissions, shorten length of stay and reduce mortality. Methods: In this retrospective study, we evaluated heart failure with reduced ejection fraction (HFrEF) admissions from 2017-2018 with a focus on 30-, 60- and 90-day all-cause readmissions, length of stay (LOS) and in-hospital mortality rate that are predicted by NT-proBNP levels measured on admission. Using the HCA Healthcare Enterprise Data Warehouse, adult patients age 18 to 75 were selected using admission ICD-10 codes for HFrEF. Dialysis patients were excluded. Our search of 90 hospitals yielded 21,445 patients who were stratified into quartiles depending on their admission NT-proBNP levels: group 1 (10,500 pg/ml). Results: Readmission Rates: The 60-day all-cause readmission was significantly (p = 0.047) higher in group 4 compared to group 1 (adjusted odds ratio (OR) = 1.116, p = 0.013) and group 2 (adjusted OR = 1.111, p = 0.014). The 90-day all cause readmission for group 4 was also significantly higher when compared to group 1 (adjusted OR = 1.105, p = 0.021).Length of Stay: Elevated NT-proBNP concentrations were associated with a significantly longer LOS (p <0.0005). Pairwise, comparisons and estimates for adjusted LOS showed a positive linear association between higher NT-proBNP groups and longer LOS.Mortality: Higher inpatient mortality rates were associated with elevated NT-proBNP levels. The mortality rate was 0.9% in group 1 compared to a 4.7% mortality rate in group 4. Adjusted OR for mortality increased with increasing levels of NT-proBNP. Conclusions: Based on the analysis, higher admitting NT-proBNP levels were associated with significantly higher 60-day all-cause readmission, longer LOS and increased mortality. These findings suggest that measuring NT-proBNP levels at admission may provide an indication of patient outcomes. Prospective studies with targeted strategies can be developed to reduce readmissions, shorten LOS and reduce mortality based on admission NT-proBNP levels.

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