Hospitalization and medical cost of patients with elevated serum N-terminal pro-brain natriuretic peptide levels

Abstract

BackgroundPatients with heart failure (HF) are reportedly at high risk for ‘all-cause’ re-hospitalization. A biomarker for HF, N-terminal pro-brain natriuretic peptide (NT-proBNP), enables to simply detect patients with possible HF (pHF). We examined the hospitalization and medical cost of Japanese patients detected by an elevated serum NT-proBNP, and also evaluated the effects of institutional team approaches for HF on their all-cause hospitalizations.MethodsWe retrospectively extracted all adult patients with serum NT-proBNP ≥400 pg/ml measured between January and March 2012 in Hiroshima University Hospital as pHF-positive patients. We studied their all-cause hospitalization records during the past 3-year period. We also extracted all pHF-negative patients with NT-proBNP <400 pg/ml and studied as well. In the pHF-positive patients followed for 3 years after starting interprofessional team approaches to prevent the onset and exacerbation of HF in the hospital, we compared the hospitalization and medical cost between the 3-year periods before and after the start of the team approaches.ResultsWe enrolled 432 pHF-positive and 485 pHF-negative patients with one or more hospitalization records. Compared to the pHF-negative patients, the pHF-positive patients had longer total hospitalization days (median [interquartile range], 30 [13–58] versus. 18 [8–39], p <0.0001) and higher total medical cost for hospitalizations (2.42 [1.07–5.08] versus. 1.80 [0.79–3.65] million yen, p <0.0001). A subset of 303 pHF-positive patients was followed for 3 years after starting the team approaches, and we found that both total hospitalization days (30 [13–57] to 8 [0–31]) and medical cost for hospitalizations (2.59 [1.37–5.05] to 0.76 [0–2.38] million yen) showed marked reduction in them.ConclusionsPatients with an elevated serum NT-proBNP have longer hospitalizations and higher costs for all-cause hospitalizations than those without. Institutional team approaches for HF may reduce them.

The utility of the adjusted-OPTIMIZE-HF risk model for predicting in-hospital length of stay in the Chinese population

“…In multivariate analyses, we found that heart rate, creatinine, sodium, NT-proBNP, EF, inotrope and non-invasive ventilation were independent predictors of LOS. Some of these results (i.e., sodium, heart rate, NT-proBNP, and creatinine) have also been reported in other studies (9)(10)(11)(12). Generally speaking, lower sodium may prolong LOS because of the dilution hyponatremia caused by the decrease of water excretion in the kidney.…”

Current Medical and Social Issues for Hospitalized Heart Failure Patients in Japan and Factors for Improving Their Outcomes ― Insights From the REAL-HF Registry ―

“…We previously reported single-center data showing that our institutional team approach reduced all-cause hospitalizations and medical costs in patients with an elevated serum HF biomarker (NT-proBNP). 23 Inpatient cardiac rehabilitation was applied to the majority of the patients in the participating institutions; however, we found that the rate of application of outpatient cardiac rehabilitation was low. Our follow-up study indicated that HF patients undergoing outpatient cardiac rehabilitation were likely to live without all-cause events.…”

Status of Medical Care and Management Requirements of Elderly Patients With Heart Failure in a Comprehensive Community Health System ― Survey of General Practitioners’ Views ―

“…Recently, Kitagawa et al reported that institutional approaches for patients with HF with elevated serum N-terminal pro B-type natriuretic peptide (NT-proBNP) may reduce the frequency, period, and medical cost for all-cause hospitalizations. 20 However, too many patients have dropped out because of variances in the clinical path. Furthermore, it requires substantial effort and cost, beyond just medical care, to maintain coordination.…”