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

Abstract

ObjectivesWe 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).MethodsData 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.ResultsFrom 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).ConclusionWhen 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.

Characterisation of the octogenarians presenting to the diagnostic heart failure clinic: SHEAF registry

“…We do not have from the SHEAF registry all the alternative diagnoses of the patients who did not have We have previously characterised the latter group of patients in our SHEAF registry (not just the octogenarians). 10 While we know from the literature that HFpEF prevalence is increasing, 5 it was interesting in our cross-sectional study that there was statistically significant, almost 59% rise in the prevalence of HFpEF over a 10-year period. However, there is a possible confounder that we have to acknowledge here: the criteria of diagnosing HFpEF changed between the two periods of data collection.…”

“…Those who do not fulfil the diagnostic echocardiographic criteria for HF, 10 may undergo further non-invasive or invasive cardiac investigations where the suspicion of HF remains high, or be referred for other non-cardiac investigations as may be appropriate. We do not have from the SHEAF registry all the alternative diagnoses of the patients who did not have HF.…”

“…Data were collected from the S heffield HEA rt F ailure (SHEAF) registry of the HF diagnostic clinic at Sheffield Teaching Hospitals. 10 The population were the octogenarian patients (aged 80–89 years) referred to the clinic with suspected HF and an N-Terminal-pro-Brain Natriuretic Peptide (NTproBNP) >400 ng/L, in two periods: From April 2012 to January 2014, and from June 2021 to December 2022. Data were analysed using Microsoft Excel.…”