Incremental B-Type Natriuretic Peptide Reductions During Heart Failure Hospitalizations: Association With Lower 30-Day Readmission And 30-Day Mortality Among Patients With Serial Assays

Introduction: Using B-type natriuretic peptide (BNP) during a heart failure (HF) hospitalization to ascertain diagnosis and prognosis has strong evidence, yet its use with serial measurement has not been established. Our aim was to examine the relationship between changes in serial BNP levels during a HF hospitalization and 30-day readmission and 30-day mortality. Methods: Data from patients admitted to any Intermountain hospital with a primary HF diagnosis from Jan 2014 - May 2017 were analyzed. A subset of data was formed with patients with serial measurements of BNP. Admission and discharge BNP values were evaluated and stratified. The primary endpoints were 30-day readmission and mortality. Results: 6887 consecutive patients were discharged with a primary diagnosis of HF. The overall readmission and mortality rates were 16.1% and 8.6% respectively. 19.1% of the patients had serial measurements of BNP. The average baseline BNP was 1256.8 ± 1079.7 and the average discharge BNP was 1004.3 ± 1029.1. Patients who had a relative reduction in BNP had a 30% lower 30-day readmission rate when compared to those without a BNP reduction (16.1% vs. 21.2%; OR 0.70, 95% CI 0.51 - 0.96, p = 0.029). Similarly, patients who had a relative reduction in BNP had a 54% lower 30-day mortality rate when compared to those without a BNP reduction (7.1% vs. 12.8%; OR 0.46, 95% CI 0.30 - 0.69, p Conclusions: Our results suggest that patients who attained an incremental reduction in BNP over their HF hospitalization had improved outcomes with reductions in 30-day readmission and mortality rates. These data suggested that perhaps serial measurements of BNP in hospitalized HF patients could become a surrogate of more favorable outcomes. Further research is needed to understand which interventions caused the drop in BNP and which patients responded.