Cardiovascular medication in patients with raised NT-proBNP, but no heart failure in the SHEAF registry

Wolodimeroff, Elena, Garg, Pankaj ORCID:, Swift, Andrew J., Fent, Graham, Lewis, Nigel, Rogers, Dominic, Charalampopoulos, Athanasios and Al-Mohammad, Abdallah (2022) Cardiovascular medication in patients with raised NT-proBNP, but no heart failure in the SHEAF registry. Open Heart, 9 (1). ISSN 2398-595X

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Objectives We aim to assess the association of cardiovascular medications with outcomes of patients referred to the diagnostic heart failure (HF) clinic with symptoms or signs of possible HF, raised N-terminal pro-brain-type natriuretic peptide (NT-proBNP) but no evidence of HF on transthoracic echocardiography (TTE). Methods Data were collected prospectively into the Sheffield HEArt Failure (SHEAF) registry between April 2012 and January 2020. The inclusion criteria were symptoms or signs suggestive of HF, NT-proBNP >400 pg/mL, but no evidence of HF on TTE. Cox proportional-hazards regression model was used to investigate the association between the survival time of patients and different cardiovascular medications. The outcome was defined as all-cause mortality. Results From the SHEAF registry, we identified 1766 patients with raised NT-proBNP with no evidence of HF on TTE. Survival was higher among the younger patients, and among those with hypertension or atrial fibrillation (AF). Mortality was increased with male gender, valvular heart disease and chronic kidney disease. Using univariate Cox proportional-hazards regression, the only cardiac therapeutic agent independently associated with all-cause mortality was beta-blocker (HR 0.86; 95% CI: 0.77 to 0.97; p=0.02). The use of beta-blockers was significantly higher in patients with AF (63% vs 39%, p<0.01) and hypertension (51% vs 42%, p<0.01). However, using multivariate Cox proportional-hazards regression to adjust for all variables associated with mortality, the influence of beta-blockers became non-significant (HR 0.96; 95% CI: 0.85 to 1.1, p=0.49). Conclusion When all variables associated with mortality are considered, none of the cardiovascular agents are associated with the improved survival of patients with suspected HF, raised NT-proBNP but no HF on echocardiography.

Item Type: Article
Additional Information: Funding Information: Funding AJS is supported by Wellcome Trust (AS: 205188/Z/16/Z). PG is supported by the Academy of Sciences Starter Grant (PG: SGL018/1100). This research was funded, in part, by the Wellcome Trust (grant number 205188/Z/16/Z). Rights retention statement: For the purpose of open access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Uncontrolled Keywords: atrial fibrillation,echocardiography,heart failure,hypertension,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
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Depositing User: LivePure Connector
Date Deposited: 07 Sep 2022 13:30
Last Modified: 15 Jul 2024 01:08
DOI: 10.1136/openhrt-2022-001974


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