Targeting Natriuretic Peptides to Reduce Mortality in Acute Decompensated Heart Failure

HealthDay News – For patients hospitalized with acute decompensated heart failure (ADHF), achieving predischarge natriuretic peptide (NP) thresholds is associated with reduced mortality and readmission, according to a review published online in the Annals of Internal Medicine.

Casey N. McQuade, MD, from the University of Pennsylvania in Philadelphia, and colleagues conducted a systematic review to examine the correlation between achieving predischarge NP thresholds and mortality and readmission in adults with ADHF. Data were included from one randomized trial, 3 quasi-experimental studies, and 40 observational studies. The most commonly used thresholds were a brain-type NP (BNP) level of 250 pg/mL or less or an amino-terminal pro-brain-type NP (NT-proBNP) decrease of 30% or more.

The researchers found that achievement of absolute BNP thresholds correlated with a reduction in post-discharge all-cause mortality and in the composite of mortality and readmission. Achievement of percentage-change BNP thresholds correlated with reductions in the composite outcome; achievement of percentage-change NT-proBNP thresholds correlated with reductions in all-cause and cardiovascular mortality, and in the composite outcome.

The randomized trial, which had a high risk of bias, indicated that a predischarge decrease in NT-proBNP level correlated with lower risk of the composite outcome.

“Low-strength evidence suggests an association between achieving NP predischarge thresholds and reduced ADHF mortality and readmission,” the authors wrote.

Disclosures: One author disclosed financial ties to the medical device and technology industries.


  1. McQuade CN, Mizus M, Wald JW, Goldberg L, Jessup M, Umscheid CA. Brain-type natriuretic peptide and amino-terminal pro-brain-type natriuretic peptide discharge thresholds for acute decompensated heart failure: a systematic review. Ann Intern Med. 2016 Nov 29. doi:10.7326/M16-1468.
  2. Felker GM, Whellan DJ. Inpatient management of heart failure: are we shooting at the right target? Ann Intern Med. 2016 Nov 29. doi:10.7326/M16-2667.