Prognostic Value of BNP Reduction during Hospitalization in Patients with Acute Heart Failure

Abstract Background Prognostication of patients discharged after acute heart failure (AHF) hospitalization remains challenging. Body weight (BW) reduction is often used as a surrogate marker of decongestion despite the paucity of evidence. We thought to test the hypothesis that B-type natriuretic peptide (BNP) reduction during hospitalization has independent prognostic value in AHF. Methods and Results We studied the prognostic predictability of percent BNP reduction achieved during hospitalization in patients from the REALITY-AHF study. Percent BNP reduction was defined as (BNP on admission - BNP at discharge) / BNP on admission × 100. The primary endpoint was 1-year all-cause death. In 1,028 patients (age, 77 ± 13 years; 57% male; left ventricular ejection fraction, 47 ± 16%) with AHF, median BNP level at admission was 747 ng/L (interquartile range, 439–1367 ng/L) and median percent BNP reduction was 62.5% (interquartile range, 36.5–78.5%). The smallest percent BNP reduction quartile had more than 2-fold higher risk of all-cause death than the greatest quartile (23.0% vs. 9.7%, p Conclusions The prognostic value of percent BNP reduction during hospitalization was superior to that of percent BW reduction and was independent of other risk markers, including BNP at discharge.