Atrial Natriuretic Peptide at Discharge as a Predictive Marker for Early Rehospitalization in Patients With Heart Failure With Preserved Ejection Fraction.

BACKGROUND

Patients admitted for heart failure with preserved ejection fraction (HFpEF) are at risk for rehospitalization, especially within 90 days post discharge. NPs (natriuretic peptides), namely ANP (atrial NP) and BNP (brain NP), are important biomarkers in HF management, but their role in predicting early rehospitalization in patients with HFpEF remains unclear.

METHODS

A retrospective analysis was conducted on 147 patients with HFpEF hospitalized for HF. ANP and BNP levels were measured at admission and discharge. Rehospitalization events were analyzed to evaluate the prognostic impact of NPs.

RESULTS

Among 147 patients, 47 (32.0%) were rehospitalized within 1 year, including 22 (15.0%) within the 90 days postdischarge. Elevated discharge ANP (>113 pg/mL) was significantly associated with early rehospitalization (log-rank =0.0053). This was confirmed in Cox models using log-transformed standardized ANP (hazard ratio [HR] per SD, 2.01 [95% CI, 1.34-3.02]; =0.0008) whereas discharge BNP levels showed weaker predictive value. Discharge ANP remained a significant predictor even after adjusting for age, body mass index, or estimated glomerular filtration ratio, whereas discharge BNP did not. Interaction analysis revealed that ANP has stronger prognostic association in patients with lower left atrial volume index ( for interaction=0.034) but not with atrial fibrillation status ( for interaction=0.217), despite a numerically stronger association in patients without atrial fibrillation.

CONCLUSIONS

Discharge ANP was a robust predictor of early rehospitalization in patients with HFpEF. These findings suggest that incorporating ANP measurements into postdischarge management may improve risk stratification to reduce early rehospitalization in patients with HFpEF.