B-type natriuretic peptide predicts 30-day readmission for heart failure but not readmission for other causes

Background-b-type natriuretic peptide (bnp) is a marker for heart failure (hf) severity,but its association with hospital readmission is not well defined. methods and results-we identified all hospital discharges (n=109 875) with a primary diagnosis of hf in the veterans affairs health care system from 2006 to 2009. we examined the association between admission (n=53 585),discharge (n=24 326),and change in bnp (n=7187) and 30-day readmission for hf or other causes. thirty-day hf readmission was associated with elevated admission bnp,elevated discharge bnp,and smaller percent change in bnp from admission to discharge. patients with a discharge bnp ≥1000 ng/l had an unadjusted 30-day hf readmission rate over 3 times as high as patients whose discharge bnp was ≤200 ng/l (15% vs. 4.1%). bnp improved discrimination and risk classification for 30-day hf readmission when added to a base clinical model,with discharge bnp having the greatest effect (c-statistic,0.639 to 0.664 [p<0.0001]; net reclassification improvement,9% [p<0.0001]). in contrast,30-day readmission for non-hf causes was not associated with bnp levels during index hf hospitalization. conclusions-in this study of over 50 000 veterans hospitalized with a primary diagnosis of hf,bnp levels measured during hospitalization were associated with 30-day hf readmission,but not readmissions for other causes. these data may help guide future study aimed at identifying the optimal timing for hospital discharge and help allocate high-intensity,hf-specific transitional care interventions to the patients most likely to benefit. © 2014 the authors.