Document resource
Introduction Based on the collective evidence from previous trials, the American Diabetes Association consensus report recommends considering screening asymptomatic adults with diabetes for the development of cardiac structural or functional abnormalities (stage B heart failure) by measurement of natriuretic peptides (BNP).Purpose In our retrospective study, we aim to describe the predictive value of elevated BNP for clinical events.Methods Patients with diabetes mellitus and cardiovascular risk factors, without symptomatic HF, were identified from the STOP-HF follow-up study and included in this report. The population was divided into patients with a normal BNP (defined as BNP <50) and elevated BNP and the number of downstream clinical events were compared between the 2 groups over a follow up period of 3 years. We examined the relationship between normal and elevated BNP to hospital admissions (characterised by HF hospitalisations, non-HF, cardiovascular hospitalisations and non – cardiovascular hospitalisations) and non-hospitalisation events.Results A total of 868 patients met the inclusion criteria. 208 (24%) of patients had an elevated BNP at baseline. At a follow up of 3 years we observed a significant difference in emergent HF hospitalisations between the 2 groups (3/660 (0.5%) vs 8/208 (3.8%) p < 0.001). There was a trend towards increase in emergent non HF, cardiovascular hospital admissions 56/660 (8.5%) vs 30/208 (14.4%) p=0.018. The elevated BNP group had an overall higher number of non-cardiac hospitalisations (177/660 (26.8%) vs 70/208 (33.7%) p = 0.069.Conclusion Previous randomized controlled trials have shown that more intensive treatment of risk factors in people with increased levels of BNP reduces the risk for symptomatic HF and HF hospitalizations. Our data supports the use of BNP as a screening tool in a high risk diabetic population to predict clinical events over a short follow up period.