B-Type Natriuretic Peptide Levels and Mortality in Patients With and Without Heart Failure

Michelle K. York, Deepak K. Gupta, Cassandra F. Reynolds, Eric Farber-Eger, Quinn S. Wells, Katherine N. Bachmann, Meng Xu, Frank E. Harrell, Thomas J. Wang

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

Background: Circulating B-type natriuretic peptide (BNP) concentrations strongly predict mortality in patients with heart failure (HF). Both cardiac and extracardiac stimuli influence BNP levels, suggesting that BNP might have similar prognostic value in patients without HF. Objectives: The aim of this study was to compare the prognostic value of BNP between patients with and those without HF. Methods: Using the Vanderbilt University Medical Center electronic health record, 30,487 patients (median age 63 years, 50% men, 17% black, 38% with HF) who had a first plasma BNP measurement between 2002 and 2013, with follow-up through 2015, were studied. The risk for death according to BNP level was quantified using multivariate Cox proportional hazards models. Results: BNP levels were lower in patients without HF (median 89 pg/ml; interquartile range: 34 to 238 pg/ml) compared with those with HF (median 388 pg/ml; interquartile range: 150 to 940 pg/ml) (p < 0.0001). Over 90,898 person-years of follow-up, 5,903 patients without HF (31%) and 6,181 patients with HF (53%) died. In multivariate models including demographic and clinical characteristics, BNP and age were the strongest predictors of death in both patients with and those without HF. In acute care settings and even among outpatients with modestly elevated BNP, the risk for death according to BNP was similar between patients with and those without HF. For instance, a BNP level of 400 pg/ml was associated with a 3-year risk for death of 21% (95% confidence interval: 20% to 23%) and 19% (95% confidence interval: 17% to 20%) in patients with and those without HF, respectively. Conclusions: Among patients without HF, plasma BNP level is a stronger predictor of death than traditional risk factors. The risk for death associated with any given BNP level is similar between patients with and those without HF, particularly in the acute care setting.

Original languageEnglish (US)
Pages (from-to)2079-2088
Number of pages10
JournalJournal of the American College of Cardiology
Volume71
Issue number19
DOIs
StatePublished - May 15 2018
Externally publishedYes

Keywords

  • death
  • electronic health record
  • prognosis
  • retrospective

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    York, M. K., Gupta, D. K., Reynolds, C. F., Farber-Eger, E., Wells, Q. S., Bachmann, K. N., Xu, M., Harrell, F. E., & Wang, T. J. (2018). B-Type Natriuretic Peptide Levels and Mortality in Patients With and Without Heart Failure. Journal of the American College of Cardiology, 71(19), 2079-2088. https://doi.org/10.1016/j.jacc.2018.02.071