Simple blood test at discharge could help reduce hospital readmissions for heart failure patients

Mar 01, 2011

An inexpensive, routine blood test could hold the key to why some patients with congestive heart failure do well after being discharged from the hospital and why others risk relapse, costly readmission or death within a year, new Johns Hopkins research suggests.

In a study reported online by the , Henry J. Michtalik, M.D., M.P.H., and his colleagues tested heart failure patients on admission and discharge for levels of a protein that's considered a marker for . In previous studies, the levels of this protein, N-terminal pro-B-type natriuretic peptide, or NT-proBNP, have been correlated with heart failure symptoms and have been associated with an increase in adverse outcomes.

They found that patients whose protein levels dropped by less than 50 percent over the course of their hospital stay were 57 percent more likely to be readmitted or die within a year than those whose levels dropped by a greater percentage.

Testing for NT-proBNP at the beginning and end of hospitalization, Michtalik says, could help doctors and hospitals make better decisions about which patients are truly ready to be released and which ones are at higher risk for relapse, readmission or worse. Typically, he adds, patients are already tested for this heart failure marker upon admission.

"These patients feel better. They look better. But this study suggests many of them may not be completely better," says Michtalik, a research and clinical fellow in the Johns Hopkins University School of Medicine's Division of General Internal Medicine. "Even though a doctor has determined the patient is ready to go home, a change in this of less than 50 percent means the patients are at much higher risk and would likely benefit from more intensive treatment, monitoring or outpatient follow up."

occurs when the heart can't pump enough blood to meet the demands of the body, resulting in heart enlargement and fluid swelling. It is most often caused by coronary artery disease, high blood pressure, heart valve disease and alcohol abuse. Roughly 5.7 million people in the United States have heart failure, which kills about 300,000 each year, and results in repeat hospitalizations for many patients. Readmission rates are a focus of efforts to reduce health care costs, Michtalik notes.

Michtalik and his colleagues studied 241 heart failure patients admitted to The Johns Hopkins Hospital between June 2006 and April 2007 who were treated with intravenous diuretics to remove fluid from the body.

Within the first 24 hours, blood was drawn from the patients and tested for NT-proBNP, and patients were treated for their symptoms by their individual doctors. Though the patients' NT-proBNP levels were tested again at discharge, the decision for or against discharge was determined by clinical judgment alone and the treating physicians were not aware of the protein's level at discharge.

Analysis showed that patients whose decreased by less than 50 percent over the course of the several days to a week that they were in the hospital were at the highest risk for readmission or death.

"Our research suggests that maybe clinical judgment isn't enough to decide whether a heart failure patient is ready to be discharged," he says. "These patients may benefit from being treated until the heart failure marker, NT-proBNP, decreases by a certain percentage, something that is not considered now."

Michtalik says a good next step would be a prospective randomized trial that examines whether hospitalized heart failure patients do better when their doctors work intensively to decrease the marker over the course of their hospital stays.

Explore further: New study finds 2.5 million basketball injuries to high school athletes in six seasons

Provided by Johns Hopkins Medical Institutions

not rated yet
add to favorites email to friend print save as pdf

Related Stories

New method assesses risks for heart failure patients

Jul 30, 2008

Data from 260 hospitals across the United States has led to the creation of a new method for physicians to more accurately determine the severity of heart failure in patients upon hospital admission, with a goal of reducing ...

New heart failure device is tested

Oct 17, 2006

Physicians at 50 U.S. medical facilities are taking part in a multinational clinical trial of a device designed to help heart failure victims.

Recommended for you

High-calorie and low-nutrient foods in kids' TV

12 hours ago

Fruits and vegetables are often displayed in the popular Swedish children's TV show Bolibompa, but there are also plenty of high-sugar foods. A new study from the University of Gothenburg explores how food is portrayed in ...

Chemical companies shore up supplement science

12 hours ago

As evidence mounts showing the potential health benefits of probiotics, antioxidants and other nutritional compounds, more and more people are taking supplements. And the chemical industry is getting in on the action. But ...

More Americans in their golden years are going hungry

12 hours ago

In a country as wealthy as the United States, it may come as a surprise that one in 12 seniors do not have access to adequate food due to lack of money or other financial resources. They are food insecure.

User comments : 0

More news stories

Man among first in US to get 'bionic eye' (Update)

A degenerative eye disease slowly robbed Roger Pontz of his vision. Diagnosed with retinitis pigmentosa as a teenager, Pontz has been almost completely blind for years. Now, thanks to a high-tech procedure ...