Ejection fraction, B-type natriuretic peptide and risk of stroke and acute myocardial infarction among patients with heart failure

Barry Greenberg, Eric D. Peterson, Jeffrey S. Berger, François Laliberté, Qi Zhao, Guillaume Germain, Dominique Lejeune, Jennifer W. Wu, Patrick Lefebvre, Gregg C. Fonarow

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Real-world data on the clinical outcomes of heart failure (HF) across the spectrum of ejection fraction (EF) and the prognostic value of B-type natriuretic peptide (BNP) have not been well examined. Hypothesis: The real-world association between the clinical outcomes of HF and EF or BNP levels may differ across different EF or BNP values. Methods: The Optum Integrated Claims-Clinical data (07/2009-09/2016) was used to identify adult patients with ≥1 HF diagnosis during hospitalization or emergency room visit. Three EF cohorts were formed: reduced (rEF; EF < 40%), mid-range (mrEF; EF 40%-49%), and preserved EF (pEF; EF ≥ 50%). Stratifications by BNP levels were performed using median BNP as cutoff between high vs low BNP (H-BNP vs L-BNP). Results: In total, 7005 HF patients with EF measurements (2456 patients with both HF and BNP measurements) were identified. rEF patients had higher risk of stroke (hazard ratio [HR] = 1.57, P = 0.010) and acute myocardial infarction (AMI) (HR = 2.42, P < 0.001) compared to pEF patients. H-BNP was associated with a significantly higher risk of mortality (P < 0.001). rEF patients with H-BNP had a significantly higher risk of stroke than those with L-BNP. Conclusions: Patients with rEF had a significantly higher rate of stroke and AMI vs pEF patients, as did patients with H-BNP vs L-BNP. The present study is the first to show the real-world association of EF and BNP (alone and in combination) with clinical outcomes, further supporting the recommendation to use these markers in clinical practice. These results may help to guide future recommendations and improve the clinical management of HF.

Original languageEnglish (US)
Pages (from-to)277-284
Number of pages8
JournalClinical Cardiology
Issue number2
StatePublished - Feb 2019
Externally publishedYes


  • B-type natriuretic peptide
  • ejection fraction
  • heart failure
  • myocardial infarction
  • real-world
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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