Cleland, JGF, Teerlink, JR, Davison, BA, Shoaib, A, Metra, M, Senger, S, Milo, O, Cotter, G, Bourge, RC, Parker, JD, Jondeau, G, Krum, H, O'Connor, CM, Torre-Amione, G, van Veldhuisen, DJ and McMurray, JJV (2017) Measurement of troponin and natriuretic peptides shortly after admission in patients with heart failure-does it add useful prognostic information? An analysis of the Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Studies (VERITAS). European Journal of Heart Failure, 19 (6). 739 -747. ISSN 1388-9842

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cleland_shoaib_2017_euro_heart_jnrl_aam_ADDED 30 AUG 2019.pdf - Accepted Version

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OBJECTIVE: Plasma concentrations of B-type natriuretic peptide (BNP) and troponin are often measured for diagnostic purposes when patients are admitted with heart failure, but their prognostic value when measured soon after admission is uncertain. We aimed to investigate the added prognostic value of admission measurements of BNP and troponins in patients with acute heart failure.

METHODS AND RESULTS: Multivariable prognostic models for death or any worsening heart failure (WHF) or rehospitalization for WHF by 30 days, 30-day death or rehospitalization for WHF, and 90-day mortality were constructed using baseline data from the Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Studies (VERITAS) including BNP and troponin I. Of 1347 patients, the median (interquartile range) value of BNP was 422 (156-945) pg/mL and 855 (63%) had measurable troponin I. By 30 days, 432 patients had died or experienced WHF. Clinical variables had only moderate predictive performance that was not substantially improved by BNP or troponin I (c-indices 0.6528 and 0.6595, respectively). By 30 days, 150 patients died or were rehospitalized for WHF. The c-index using clinical variables (0.6855) was not improved by adding biomarkers. By 90 days, 135 patients had died. The c-index for mortality was somewhat better than for composite outcomes (0.7394) but improved little with biomarkers (0.7461).

CONCLUSION: Routine clinical data recorded at the time of admission in patients with acute heart failure are poor at predicting recurrent admissions but somewhat better at predicting mortality. Neither BNP nor troponin measured at admission improved predictions; measurement closer to discharge, or of other novel biomarkers, might perform differently.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Wiley-Blackwell at - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: acute heart failure, biomarkers, prognosis, statistical models, acute disease, aged, dose-response relationship, drug, europe, female, follow-up studies, heart failure, hospital mortality, humans, injections, intravenous, male, middle aged, natriuretic peptide, brain, patient admission, patient discharge, pyridines, receptors, endothelin, retrospective studies, survival rate, tetrazoles, time factors, troponin i, united states, vasodilator agents
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
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Depositing User: Symplectic
Date Deposited: 30 Aug 2019 09:16
Last Modified: 30 Aug 2019 09:18

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