Predictor of mortality and rehospitalization of acute decompensated heart failure at six months follow up

Objective: To look for predictors of mortality and rehospitalization, we conducted a prospective study using fifty variables from history, physical examination, ECG, CXR, Echocardiography and blood test (N Terminal proBNP, hsCRP, and lactate level) that suspected as predictors in heart failure Design: Blinded prospective cohort study Setting: Emergency room of Harapan Kita National Heart Center, Jakarta-Indonesia as entry site, with ICCU, wards, and OPD for evaluation. Patients population for study. All consecutive patients with acute decompensated heart failure class III-IV that were hospitalized. Exclusion criteria were other concomitant severe diseases. Measurements and result: Of 97 patients enrolled, variables were measured using standard protocols. During follow up period of six months, 11 (11.3%) patients died of cardiac origin and 29 (29.9%) rehospitalized. Logistic regression analysis revealed BMI >30 kg/m² with edema had OR 6.6 (95% CI: 1.33-32.72, p=0,021), acute lung edema had OR 3,65 (CI 0,99-13,35, p=0,037), NYHA class IV had OR 5,42 (CI 95% : 1,11-26,59, p=0,037), left ventricle wall thickness >11 mm had OR 0,79 (CI 95 %: 0,63-1,00, p= 0,05), using beta-blocker had OR 0,09 (CI 95%: 0,01-0,74, p= 0,025), hemoglobin <12 g/dL had OR 4,53 (CI 95%: 1,24-16,56, p= 0,022), sodium <130 mmol/dL had OR 3,78( CI 95%: 1,02-14,03,p=0,047), NT proBNP >17,860 pg/mL on admission had OR 9,02 (CI 95 %: 2.30-35.30, p=0,02) or NT proBNP > 8,499 pg/dL at discharge had OR 13,2 (CI95%: 1,32-132,01, p=0,028) and served as predictors of mortality respectively. Using Cox Proportional Hazards and Kaplan Meier survival analysis and log rank test it were found that NT proBNP level >17.860 pg/ml on admission had a HR of 7.15 (95% CI 2.08-24.56, p=002) for mortality, while NT proBNP level >8.499 at discharged showed a HR of 9.55 (95% CI 1.06-85.77, p=0.044) for mortality. A decrease >35% of NT proBNP had a HR 0.13 (95%CI 0.02-1.19, p=0.071) for mortality, 0.38 (95% CI 0.14-1.00, p=0.049) for rehospitalization, and 0.42 (95%CI 0.12-0.76, p=0.010) for both. NT proBNP on admission >17.860 pg/dL together with EF <20 %, BMI >30 kg/m² with edema and NYHA class IV were the most accurate predictor with AUC =0,94 (P=0.0001). Conclusion. Non decreased NT proBNP > 35 % during hospitalization was the predictor of mortality and rehospitalization. NT proBNP>17,860 pg/mL at entry, NT proBNP > 8,499 pg/mL at discharged, NYHA class IV, BMI>30 kg/m² with edema, EF <20%, acute pulmonary edema, Rb <12 g/dL, Na <130 mmol/dL and not using beta-blocker were found as predictors for mortality of heart failure.