Clinical question: Does B-type natriuretic peptide (BNP) have prognostic value outside of heart failure (HF) patients?
Background: BNP levels are influenced by both cardiac and extracardiac stimuli and thus might have prognostic value outside of the traditional use to guide therapy for HF patients.
Study design: Retrospective cohort study of the Vanderbilt electronic health record.
Setting: Vanderbilt University Medical Center, Nashville, Tenn.
Synopsis: The study evaluated 30,487 patients with at least two BNP values for 2002-2015. Within this cohort, 62% of patients did not have a HF diagnosis. Risk of death was elevated in all patients regardless of HF status as BNP values rose. An increase from the 25th to 75th percentile in BNP value was associated with an increased risk of death in non-HF patients (hazard ratio, 2.08; 95% confidence interval, 1.99-2.2). Additionally, in a multivariate analysis BNP was the strongest predictor of death, compared with traditional risk factors in both HF and non-HF patients. The main limitation to this study was the use of ICD codes for diagnosis of HF.
Bottom line: BNP has predictive value for risk of death in non-HF patients; as BNP levels rise, regardless of HF status, so does risk of death.
Citation: York MK et al. B-type natriuretic peptide levels and mortality in patients with and without heart failure..
Dr. Abramowicz is an assistant professor in the division of hospital medicine, University of Colorado, Denver.