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NT-proBNP Guided Discharge — EECC MCQ

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ModerateHeart FailureNT-proBNP Guided DischargeEECC

A 72-year-old man with HFpEF (LVEF 60%), AF, hypertension, and diabetes is admitted for acute decompensated HF. His NT-proBNP on admission is 4,200 pg/mL and on discharge is 2,100 pg/mL (50% reduction). Is this NT-proBNP reduction adequate?

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Correct answer: E — A ≥30% reduction in NT-proBNP during hospitalisation for AHF is associated with improved post-discharge outcomes and suggests adequate decongestion

Serial NT-proBNP measurement during HF hospitalisation provides prognostic information and helps guide decongestion adequacy. A ≥30% reduction in NT-proBNP from admission to discharge is associated with significantly lower 30-day and 6-month mortality and readmission rates. Complete normalisation is rarely achievable and is not required. The ESC HF Guidelines recommend using NT-proBNP to guide in-hospital management and optimise the timing of discharge (Class IIa). Patients discharged with persistently elevated or rising natriuretic peptides have substantially worse outcomes and may benefit from extended hospitalisation for further decongestion and GDMT optimisation. This applies across the EF spectrum including HFpEF.

Reference: ESC (2023): Focused Update on Heart Failure