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European Heart Journal Advance Access originally published online on November 23, 2008
European Heart Journal 2009 30(1):66-73; doi:10.1093/eurheartj/ehn525
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Prognostic threshold levels of NT-proBNP testing in primary care

Jens Rosenberg1,*, Morten Schou1, Finn Gustafsson2, Jørn Badskjær3 and Per Hildebrandt4

1 Department of Cardiology, Frederiksberg University Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
2 Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
3 Københavns Praktiserende Lægers Laboratorium, Pilestræde 65, 1112 København K, Denmark
4 Department of Cardiology, Glostrup University Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark

Received 4 August 2008; revised 22 September 2008; accepted 31 October 2008; online publish-ahead-of-print 23 November 2008.

* Corresponding author. Tel: +45 38 16 43 78, Fax: +45 38 16 43 59, Email: cor{at}dadlnet.dk

Aims: Chronic heart failure (HF) is a common condition with a poor prognosis. As delayed diagnosis and treatment of HF patients in primary care can be detrimental, risk-stratified waiting lists for echocardiography might optimize resource utilization. We investigated whether a prognostic threshold level of the cardiac peptide, NT-proBNP, could be identified.

Methods and results: From 2003–2005, 5875 primary care patients with suspected HF (median age 73 years) had NT-proBNP analysed in the Copenhagen area. Eighteen percent died and 20% had a cardiovascular (CV) hospitalization (median follow-up time: 1127 and 1038 days, respectively). In Cox proportional hazards regression models regarding NT-proBNP levels, the fourth decile (range: 83–118 pg/mL) was associated with a 90% (95% CI: 30–190, P < 0.01) increased risk for CV hospitalization and the seventh decile (range: 229–363 pg/mL) was associated with an 80% (95% CI: 20–190, P = 0.01) increased mortality risk after adjustment for age, sex, previous hospitalization, CV diseases, and chronic diseases.

Conclusion: We identified prognostic threshold levels for mortality and CV hospitalization for NT-proBNP in primary care patients suspected of HF. Our results have the potential to be used to risk-stratify waiting lists for echocardiography.

Key Words: Brain natriuretic peptide • Prognosis • Congestive heart failure • Primary care


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