Variables associated with readmission for heart failure in patients in the grey zone

Identifier:  TFG:9036

Handle: https://hdl.handle.net/20.500.11797/TFG9036

Authors:  González i Escofet, Roser

Abstract:
Heart failure is a prevalent syndrome in the population over 65 years of age, characterised by complex clinical features and frequently non-specific symptoms. The key biomarker for diagnosis is NT-proBNP. This biomarker is interpreted using different pre-validated cut-off points. A value below 300 pg/ml (rule-out) allows the diagnosis to be ruled out. To confirm the diagnosis, age-adjusted cut-off points (rule-in) have been established: ≥450 pg/ml for patients under 50 years of age, ≥900 pg/ml for patients aged 50 to 75 years, and ≥1800 pg/ml for patients aged 50 to 75 years. If NT-proBNP concentrations are in the range where HF cannot be confirmed or ruled out (grey zone), the diagnosis depends on the clinical judgement of the treating physician. Knowledge of the clinical characteristics and prognosis of patients with NT-proBNP measurements in this grey zone has been little explored to date. In order to characterise patients with NT-proBNP in the grey zone, an observational and retrospective study was conducted that included as the study group patients with NT-proBNP levels in the grey zone and as the control group patients with NT-proBNP levels below 300 pg/ml (rule-out). The clinical characteristics and factors associated with readmission for heart failure were analysed. The results showed that dyspnea, orthopnea, history of myocardial infarction, higher NT-proBNP levels (within the grey zone) and low CRP levels are variables associated with the risk of hospitalization. Specifically, NT-proBNP and CRP increase the discriminatory power of a clinical prognostic model in assessing the risk of adverse events during follow-up.