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Limited value of NT-proBNP as a prognostic marker of all-cause mortality in patients with heart failure with preserved and mid-range ejection fraction in primary care: A report from the swedish heart failure register
Karolinska Inst, Sweden.
Karolinska Inst, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0001-6353-8041
KTH Royal Inst Technol, Sweden.
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2019 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim: The prognostic value of natriuretic peptides in the management of heart failure (HF) patients with ejection fraction (EF) amp;lt;40% is well established, but is less known for those with EF amp;gt;= 40% managed in primary care (PC). Therefore, the aim of this study is to describe the prognostic significance of plasma NT-proBNP in such patients managed in PC. Subjects: We included 924 HF patients (48% women) with EF amp;gt;= 40% and NT-proBNP registered in the Swedish Heart Failure Registry. Follow-up was 1100 +/- 687 days. Results: One-, three- and five-year mortality rates were 8.1%, 23.9% and 44.7% in patients with EF 40-50% (HFmrEF) and 7.3%, 23.6% and 37.2% in patients with EF amp;gt;= 50% (HFpEF) (p = 0.26). Patients with the highest mean values of NT-proBNP had the highest all-cause mortality but wide standard deviations (SDs). In univariate regression analysis, there was an association only between NT-proBNP quartiles and all-cause mortality. In HFmrEF patients, hazard ratio (HR) was 1.96 (95% CI 1.60-2.39) p amp;lt; 0.0001) and in HFpEF patients, HR was 1.72 (95% CI 1.49-1.98) p amp;lt; 0.0001). In a multivariate Cox proportional hazard regression analysis, adjusted for age, NYHA class, atrial fibrillation and GFR class, this association remained regarding NT-proBNP quartiles [HR 1.83 (95% CI 1.38-2.44), p amp;lt; 0.0001] and [HR 1.48 (95% CI 1.16-1.90), p = 0.0001], HFmrEF and HFpEF, respectively. Conclusion: NT-proBNP has a prognostic value in patients with HF and EF amp;gt;= 40% managed in PC. However, its clinical utility is limited due to high SDs and the fact that it is not independent in this population which is characterized by high age and much comorbidity.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD , 2019.
Keywords [en]
Heart failure; EF >= 40%; primary care; NT-proBNP; prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-162312DOI: 10.1080/02813432.2019.1684029ISI: 000496383300001PubMedID: 31724475OAI: oai:DiVA.org:liu-162312DiVA, id: diva2:1374053
Note

Funding Agencies|Swedish National Board of Health and Welfare; Swedish Association of Local Authorities and Regions; Swedish Society of Cardiology

Available from: 2019-11-28 Created: 2019-11-28 Last updated: 2020-01-16

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Dahlström, Ulf
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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