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N-terminal brain natriuretic peptide and subsequent hospital admission for worsening heart failure
  1. M R Cowie1,
  2. C Metcalfe2,
  3. K F Fox3,
  4. G C Sutton1
  1. 1National Heart and Lung Institute, Imperial College, London, UK
  2. 2Department of Social Medicine, University of Bristol, Bristol, UK
  3. 3Cardiovascular Research Group, Imperial College, Charing Cross Hospital, London
  1. Correspondence to:
    Professor Martin R Cowie
    Clinical Cardiology, National Heart and Lung Institute, Imperial College, Dovehouse Street, London, SW3 6LY, UK;

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Recurrent and lengthy hospitalisation is common in patients with heart failure and accounts for much of the treatment cost. This has led to interventions aimed at reducing hospitalisation, but identifying patients at risk of hospitalisation is difficult using traditional risk factors.1 Evidence accumulates for the value of brain natriuretic peptide (BNP) and N-terminal brain natriuretic peptide (NT-proBNP) in the diagnosis and management of heart failure.2 In addition, one study has compared patients with plasma concentrations of NT-proBNP above and below a median of 825 pg/ml, observing a relative risk for hospitalisation with heart failure of 4.7 (95% confidence interval (CI) 2.2 to 10.3; p < 0.001).3 Patients in that study had chronic, stable heart failure caused by coronary artery disease (CAD) and were participating in a clinical trial. Trial exclusion criteria included a current New York Heart Association (NYHA) rating of IV. In the present study, we examined a UK population cohort of incident cases of heart failure to assess whether NT-proBNP could identify patients at risk of subsequent hospitalisation.


The Bromley heart failure study was designed to identify all new cases of heart failure in Bromley, UK, through general practitioner surveillance and daily screening of hospital admissions.1 Heart failure was diagnosed if a patient had symptoms (shortness of breath or fatigue) with clinical signs of fluid retention in the presence of an underlying abnormality of cardiac structure …

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  • Conflicts of interest: MRC advises several companies that manufacture assays for natriuretic peptides. MRC was the clinical adviser for the NICE guideline on the diagnosis and management of chronic heart failure, but the views expressed here are his own and should not be taken to necessarily reflect those published in the guideline