BNP levels at the admission are related with days of hospitalization in patients with acute heart failure and the overall risk of death

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), 101–500 pg/ml (group 2), 501–1500 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–Meier 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 ± 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: 13.7–19.5) than patients in group 3 (13.1 days, 95 %CI:11.7–14.6) or group 2 (12.3 days, 95 % CI: 10.6–13.9) (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 stratification