Patients with improved NT-proBNP levels but deteriorated KCCQ-12 scores one month after discharge had an increased risk of one-year all-cause death (HR 2.45; 95% CI 1.34-4.48).
Cohort (n=2,461)
Yes
Do changes in patient-reported health status (KCCQ-12) provide complementary prognostic information to NT-proBNP levels for predicting death and rehospitalization in patients with acute heart failure?
Changes in patient-reported health status (KCCQ-12) correlate weakly with NT-proBNP changes and provide independent, complementary prognostic information for mortality in patients recovering from acute heart failure.
Hazard Ratio: 2.45 (95% CI 1.34–4.48)
BACKGROUND: Changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels may not fully translate into patient-reported health status in patients with heart failure (HF). We aimed to evaluate the correlation between NT-proBNP levels and patient-reported health status changes at one month after discharge of patients, and their associations with risk of death and rehospitalization in patients with acute HF. METHODS: We used data from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (PEACE 5p-HF Study). Patient-reported health status was measured by the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Patients who were hospitalized for HF and completed the KCCQ-12 and NT-proBNP tests before and one month after discharge were eligible in our study. We stratified patients into different groups based on NT-proBNP levels (i.e., improved, stable, and deteriorated) and KCCQ-12 scores (i.e., not deteriorated and deteriorated). We also examined the associations of the joint NT-proBNP and KCCQ-12 change with the risk of one-year and four-year clinical outcomes. RESULTS: A total of 2461 patients were included in the analysis. The mean age was 64.06 ± 13.51 years, and 36.37% (895/2461) of the study population were female. Among patients with improved NT-proBNP levels, 115 (10.95%) patients had deteriorated KCCQ-12 scores. The correlation between the change in the KCCQ-12 score and NT-proBNP level was weak ( r2 = 0.002, P = 0.013). Stratification by changes in the KCCQ-12 score revealed subgroups with distinctive risks, such that patients with deteriorated KCCQ-12 scores in any of the NT-proBNP change groups exhibited an increased risk of one-year all-cause death than participants with not deteriorated KCCQ-12 scores in any of the NT-proBNP change groups. Patients with improved NT-proBNP levels and deteriorated KCCQ-12 scores presented greater risks of one-year all-cause death (hazard ratio HR: 2.45, 95% confidence interval CI: 1.34-4.48) than patients with stable NT-proBNP levels and not deteriorated KCCQ-12 scores (HR 95% CI, 1.77 1.25-2.53). CONCLUSIONS: A discrepancy between changes in NT-proBNP levels and KCCQ-12 scores was common. The change in NT-proBNP levels was not sufficient to characterize critical aspects related to HF during one month after discharge of patients. Changes in the KCCQ-12 score exhibit complementary information to NT-proBNP levels for the prediction of clinical outcomes in patients with acute HF. REGISTRATION: www.clinicaltrials.gov (No. NCT02878811).
Li et al. (Tue,) conducted a cohort in Acute heart failure (n=2,461). Deteriorated KCCQ-12 scores with improved NT-proBNP levels vs. Stable NT-proBNP levels and not deteriorated KCCQ-12 scores was evaluated on One-year all-cause death (HR 2.45, 95% CI 1.34-4.48). Patients with improved NT-proBNP levels but deteriorated KCCQ-12 scores one month after discharge had an increased risk of one-year all-cause death (HR 2.45; 95% CI 1.34-4.48).