What is the clinical evidence from this study?

Study design: Cohort. Population: Suspected heart failure with raised NTproBNP and no heart failure on echocardiography (n=1031). Intervention: Clinical predictors (observational). Primary outcome: All-cause mortality.

June 4, 2020Open Access

Clinical Predictors of All-Cause Mortality in Patients Presenting to Specialist Heart Failure Clinic with Raised NT-ProBNP and no Heart Failure

Key Result

In patients with raised NTproBNP but no heart failure on echocardiography, all-cause mortality was 21.5% over 6 years, independently predicted by age, male gender, CKD, COPD, and dementia.

Study Design

Type

Cohort (n=1,031)

Multicenter

Structured PICO

Population

1031 patients presenting with symptoms raising suspicion of heart failure, NTproBNP > 400 pg/mL, preserved left ventricular function, and no echocardiographic evidence of any type of heart failure.

Outcome

All-cause mortalityhard clinical

Patients with suspected heart failure and raised NT-proBNP but no echocardiographic evidence of heart failure have significant long-term mortality driven by age and non-cardiac comorbidities.

Abstract

AIMS: Clinical outcomes for patients suspected of having heart failure (HF) who do not meet the diagnostic criteria of any type of HF by echocardiography remain unknown. The aim of this study was to investigate the clinical predictors of all-cause mortality in patients with suspected HF, a raised N-terminal pro-b-type natriuretic peptide (NTproBNP) and who do not meet the diagnostic criteria of any type of HF by echocardiography. METHODS AND RESULTS: Relevant data were taken from the Sheffield HEArt Failure (SHEAF) registry (222349P4). The inclusion criteria were presence of symptoms raising suspicion of HF, NTproBNP > 400 pg/mL, and preserved left ventricular function. Exclusion criteria were any type of HF by echocardiography. The outcome was defined as all-cause mortality. Cox proportional-hazards regression model was used to investigate the association between the survival time of patients and clinical variables; 1031 patients were identified with NTproBNP > 400 pg/mL but who did not have echocardiographic evidence of HF. All-cause mortality was 21.5% (222 deaths) over the mean follow-up (FU) period of 6 ± 2 years. NTproBNP was similar in patients who were alive or dead (P = 0.96). However, age (HR 1, P 627 pg/mL, NYHA class predicted death (II, 19.6%; III, 27.4%; IV, 66.7%; P 627 pg/mL coupled with NYHA class could identify patients at greatest risk of death.