Prognostic factors of mid-term clinical outcome in congestive heart failure patients discharged after acute decompensation

Abstract

Introduction: Risk stratification in congestive heart failure (CHF) patients is based on a variety of clinical and laboratory variables. We analysed renal function, BNP, water composition, echocardiographic and functional determinations in predicting mid-term outcome in CHF patients discharged after decompensation.

Material and methods: All subjects with NYHA class II-IV were enrolled at hospital discharge. NYHA class, BNP, water body composition, non-invasive cardiac output and echocardiogram were analysed. Death, cardiac transplantation and hospital readmission for CHF were scheduled.

Results: Two-hundred and thirty-seven (64.5% males, age 71.1±10.1) patients were discharged after obtaining normal hydration; left ventricular ejection fraction (LVEF) was 43.2±16.2%, cardiac output was 3.8±1.1 l/min and BNP at discharge resulted 401.3±501.7 pg/ml. During the 14-month follow-up 15 patients (6.3%) died, 1 (0.4%) underwent cardiac transplantation and 18 (7.6%) were readmitted for CHF (event group); in 203 (85.6%) no events were observed (no-event group). Higher NYHA class (2.1±0.7 vs. 1.9±0.4, p=0.01), BNP at discharge (750.2±527.3 pg/ml vs. 340.7±474.3 pg/ml, p=0.002) and impaired LVEF (33.7±15.7% vs. 44.5±15.8%, p=0.0001) and creatinine (1.7±0.6 vs. 1.2±0.8 mg/dl, p=0.004) were noticed in the event group. At multivariate Cox analysis LVEF (p=0.0009), plasma creatinine (p=0.006) and BNP at discharge (p=0.001) were associated with adverse mid-term outcome. Kaplan-Meier survival curves demonstrated that adding cut-off points for creatinine 1.5 mg/dl and discharged BNP of 250 pg/ml discriminated significantly prognosis (p=0.0001; log rank 21.09).

Conclusions: In predicting mid-term clinical prognosis in CHF patients discharged after acute decompensation, BNP at discharge ≥ 250 pg/ml added with plasma creatinine > 1.5 mg/dl are strong adverse predictors.

Keywords: congestive heart failure; natriuretic peptide; prognosis.

Figure 1

Evaluation of grade of hydration in CHF patients using the BIVA giagram and nomogram; on the left the same patients at time A presents hyper-hydration (+3 SD) that was reduced after diuretic therapy (point B)

Figure 2

Event-free curves in CHF patients according to the LVEF

Figure 3

Event-free curves in CHF patients according to the left ventricular systolic diameter

Figure 4

Event-free curves in CHF patients according to plasma creatinine

Figure 5

Event-free curves in CHF patients according to plasma BNP at admission

Figure 6

Event-free curves in CHF patients according to plasma BNP at discharge

Figure 7

Event-free curves in CHF patients according to diastolic filling pattern obtained with transthoracic echocardiography before discharge

Figure 8

Event-free curves in CHF patients according to plasma BNP at discharge added to serum creatinine