BOCA RATON, FLA. — A quick test of brain natriuretic peptide can predict which outpatients with heart failure are most likely to be admitted to the hospital within 30 days of the test, according to a poster presentation at the annual meeting of the Heart Failure Society of America.
In a previous study, the collaborative care outpatient program at Community Hospital in Munster (Ind.) significantly reduced the need for inpatient care. However, some patients were still hospitalized within 30 days of enrollment for the program. So Miguel Gambetta, M.D., and his colleagues conducted another study to identify any baseline variables that might predict admission within the 30-day time frame.
A cardiologist, an advanced practice nurse, and a team of registered nurses staff the collaborative care program, which features an infusion clinic, heart failure education, and telemedicine follow-up. Primary goals include management of signs and symptoms of heart failure decomposition and prevention of hospital admission.
The study included 1,404 heart failure patients in the program, of whom 856 were men. The mean age was 77 years. Researchers assessed heart rate, blood pressure, respiratory rate, and brain natriuretic peptide levels taken at enrollment for patients who were admitted within 30 days.
“Admissions are an indication of how the patient is doing, so we can predict which patients will do well with a short-term prognosis,” Dr. Gambetta, a private practice cardiologist in Munster, said in an interview.
Brain natriuretic peptide (BNP) is a hormone excreted by the heart when under stress, explained coauthor Patrick Dunn, MS, MBA, in an interview. By using point-of-care testing, a serum BNP level can be measured in about 30 minutes, so it could have value in an emergency department setting.
“Heart failure is a huge problem—our hospital has about 800 admissions per year. We want to more accurately predict who is at high risk,” said Mr. Dunn, who is now director of cardiovascular development at Las Colinas Medical Center, Irving, Tex. He was director of data management at Community Hospital at the time of the study.
A total of 75 participants (5%) in the study were admitted to the hospital within 30 days of enrollment. BNP was the only significant predictor. If a heart failure outpatient has a BNP level of 651 pg/mL or greater, they are 2.5 times more likely to be admitted [to the hospital] within 30 days, Mr. Dunn said.
“We were not surprised by our results—we assumed this was very useful,” Dr. Gambetta said. Mr. Dunn added, “BNP is a very good predictor of admission, even with outpatients.”