Clinical value of pre‐discharge bio‐adrenomedullin as a marker of residual congestion and high risk of heart failure hospital readmission. (3rd December 2019)

• Record Type: Journal Article
• Authors: Pandhi, Paloma; ter Maaten, Jozine M.; Emmens, Johanna E.; Struck, Joachim; Bergmann, Andreas; Cleland, John G.; Givertz, Michael M.; Metra, Marco; O'Connor, Christopher M.; Teerlink, John R.; Ponikowski, Piotr; Cotter, Gad; Davison, Beth; van Veldhuisen, Dirk J.; Voors, Adriaan A.
• Is Part Of: European journal of heart failure. Volume 22:Number 4(2020)
• Page Start: 683
• Page End: 691
• Publication Date: 2019-12-03
• Subjects: Bio‐adrenomedullin -- Loop diuretics -- Acute heart failure; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.1693
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract: Aims: Recently, bio‐adrenomedullin (bio‐ADM) was proposed as a congestion marker in heart failure (HF). In the present study, we aimed to study whether bio‐ADM levels at discharge from a hospital admission for worsening HF could provide additional information on (residual) congestion status, diuretic dose titration and clinical outcomes. Methods and results: Plasma bio‐ADM was measured in 1236 acute HF patients in the PROTECT trial at day 7 or discharge. Median discharge bio‐ADM was 33.7 [21.5–61.5] pg/mL. Patients with higher discharge bio‐ADM levels were hospitalised longer, had higher brain natriuretic peptide levels, and poorer diuretic response (all P < 0.001). Bio‐ADM was the strongest predictor of discharge residual congestion (clinical congestion score > 3) (odds ratio 4.35, 95% confidence interval 3.37–5.62; P < 0.001). Oedema at discharge was one of the strongest predictors of discharge bio‐ADM (β = 0.218; P < 0.001). Higher discharge loop diuretic doses were associated with a poorer diuretic response during hospitalisation (β = 0.187; P < 0.001) and higher bio‐ADM levels (β = 0.084; P = 0.020). High discharge bio‐ADM levels combined with higher use of loop diuretics were independently associated with a greater risk of 60‐day HF rehospitalisation (hazard ratio 4.02, 95% confidence interval 2.23–7.26; P < 0.001). Conclusion: In hospitalised HF patients, elevated pre‐discharge bio‐ADM levels were associated with higher discharge loop diuretic doses and reflected residual congestion. Patients with combined higher bio‐ADM levels and higher loop diuretic use at discharge had an increased risk of rehospitalisation. Assessment of discharge bio‐ADM levels may be a readily applicable marker to identify patients with residual congestion at higher risk of early hospital readmission.