eprintid: 164209 rev_number: 28 eprint_status: archive userid: 9439 dir: disk0/00/16/42/09 datestamp: 2018-06-19 15:57:49 lastmod: 2021-10-06 11:03:39 status_changed: 2018-06-19 15:57:49 type: article metadata_visibility: show creators_name: Zhang, J. creators_name: Pellicori, P. creators_name: Pan, D. creators_name: Dierckx, R. creators_name: Clark, A.L. creators_name: Cleland, J.G.F. creators_orcid: 0000-0001-7175-0464 creators_orcid: 0000-0002-1471-7016 title: Dynamic risk stratification using serial measurements of plasma concentrations of natriuretic peptides in patients with heart failure ispublished: pub divisions: 25606000 full_text_status: public abstract: Background: Prognostic models for patients with chronic heart failure are generally based on a single assessment but treatment is often given with the intention of changing risk; re- evaluation of risk is an important aspect of care. The prognostic value of serial measurements of natriuretic peptides for the assessment of changes in risk is uncertain. Aims: To evaluate the prognostic value of serial measurements of plasma amino-terminal pro-brain natriuretic peptide (NT-proBNP) during follow-up of out-patients with chronic heart failure (CHF). Methods: Patients diagnosed with CHF between 2001 and 2014 at a single out-patient clinic serving a local community were included in this analysis. NT-proBNP was measured at the initial visit and serially during follow-up. Only patients who had one or more measurements of NT-proBNP after baseline, at 4, 12 and/or 24 months were included. Results: At baseline, amongst 1,998 patients enrolled, the median age was 73 (IQR: 64-79) years, 70% were men, 31% were in NYHA class III/IV, 58% had a reduced ejection fraction and 77% had NT-proBNP >400 pg/ml. Median follow-up was 4.8 (IQR 2.5-8.6) years. Serial measurements of NT-proBNP improved prediction of all-cause mortality at 3 years (c- statistic=0.71) compared with using baseline data only (c-statistic=0.67; p<0.001) but a model using only the most recent NT-proBNP had an even higher c-statistic (0.72; p<0.001). Similar results were obtained based on long-term prediction of mortality using all available follow-up data. Conclusions: Serial measurement of NT-proBNP in patients with CHF improves prediction of all-cause mortality. However, using the most recent value of NT-proBNP has similar predictive power as using serial measurements. date: 2018-10-15 date_type: published publication: International Journal of Cardiology volume: 269 publisher: Elsevier pagerange: 196-200 id_number: 10.1016/j.ijcard.2018.06.070 refereed: TRUE issn: 0167-5273 copyright_holders: Copyright © 2018 Elsevier B.V. prior: First published in International Journal of Cardiology 269: 196-200 repro: Reproduced in accordance with the copyright policy of the publisher uniqueid: glaseprints:2018-164209 issn_online: 1874-1754 pubmed_id: 30001941 euro_pubmed_id: 30001941 hoa_compliant: 511 hoa_emb_len: 12 hoa_ref_pan: AB hoa_date_acc: 2018-06-18 hoa_date_pub: 2018-06-25 hoa_date_foa: 2019-06-26 hoa_version_fcd: AM hoa_exclude: FALSE hoa_gold: FALSE oa_research_materials_ack: No citation: Zhang, J., Pellicori, P. , Pan, D., Dierckx, R., Clark, A.L. and Cleland, J.G.F. (2018) Dynamic risk stratification using serial measurements of plasma concentrations of natriuretic peptides in patients with heart failure. International Journal of Cardiology , 269, pp. 196-200. (doi: 10.1016/j.ijcard.2018.06.070 ) (PMID:30001941) document_url: https://eprints.gla.ac.uk/164209/13/164209.pdf document_url: https://eprints.gla.ac.uk/164209/2/164209Suppl.pdf