Background: Acute Heart Failure (AHF) is a frequent condition
associated to poor prognosis among elderly patients admitted to
Internal Medicine departments (IMDs). Length of hospitalization is
associated to higher mortality among medical patients. Increased
brain natriuretic peptide (BNP) levels have been associated, in this
subset, to a raised mortality and morbidity.
Aims: to evaluate whether BNP levels at admission could be associated
to longer hospitalizations and survival time in the subset of
patients who die of AHF.
Methods: we enrolled 400 consecutive patients admitted to our IMD
with a clinical diagnosis ofAHF.BNPwas evaluated in all patients at the
admission. Subjects were stratified in four categories: BNP less than
100 pg/ml (group 1), 101\u2013500 pg/ml (group 2), 501\u20131500 pg/ml (group
3) and BNP higher than 1501 pg/ml (group 4). Each patient underwent to
a complete diagnosticworkup. PatientswithBNP levels less than 100 pg/
ml or a final diagnosis other than AHF were excluded. Kaplan\u2013Meier
model with log-rank test was used to assess the differences. Statistical
analysis was performed with SPSS 13 package for Windows systems.
Results: 293 patients were suitable for final analysis. Mean age was
80 \ub1 9.85 years, males representing 58 % of the sample. Among
patients who were successfully dismissed, group 4 had a significantly
longer hospitalization time (16.6 days, 95 %CI: 13.7\u201319.5) than patients
in group 3 (13.1 days, 95 %CI:11.7\u201314.6) or group 2 (12.3 days, 95 %
CI: 10.6\u201313.9) (p\0.05, all ties, Figure 1).Among patientswho died of
AHF, subjects in group 2 had a significantly longer survival time (mean:
46.0 days, SE 3.71) than patients in group 3 (mean: 36.7 days, SE 2.51)
or group 4 (mean: 22.9 days, SE 1.88) (p\0.05, all ties, Figure 2).
Conclusions: BNP is useful for diagnosis and prognostic stratification
in patients with AHF. If confirmed in larger cohorts, it could
also be used to predict longer hospitalizations among specific
subsets of patients. Among elderly patients admitted into IMD who
will die of AHF, higher BNP levels are independently associated to
a faster progression of the pathology and death. BNP levels at the
admission of patients should be considered as a powerful tool
that can help the physicians not only in diagnosis but also in
the prognostic stratificatio
