Navigation Links
Simple blood test at discharge could help reduce hospital readmissions for heart failure patients
Date:2/28/2011

An inexpensive, routine blood test could hold the key to why some patients with congestive heart failure do well after being discharged from the hospital and why others risk relapse, costly readmission or death within a year, new Johns Hopkins research suggests.

In a study reported online by the American Journal of Cardiology, Henry J. Michtalik, M.D., M.P.H., and his colleagues tested heart failure patients on admission and discharge for levels of a protein that's considered a marker for heart stress. In previous studies, the levels of this protein, N-terminal pro-B-type natriuretic peptide, or NT-proBNP, have been correlated with heart failure symptoms and have been associated with an increase in adverse outcomes.

They found that patients whose protein levels dropped by less than 50 percent over the course of their hospital stay were 57 percent more likely to be readmitted or die within a year than those whose levels dropped by a greater percentage.

Testing for NT-proBNP at the beginning and end of hospitalization, Michtalik says, could help doctors and hospitals make better decisions about which patients are truly ready to be released and which ones are at higher risk for relapse, readmission or worse. Typically, he adds, patients are already tested for this heart failure marker upon admission.

"These patients feel better. They look better. But this study suggests many of them may not be completely better," says Michtalik, a research and clinical fellow in the Johns Hopkins University School of Medicine's Division of General Internal Medicine. "Even though a doctor has determined the patient is ready to go home, a change in this biological marker of less than 50 percent means the patients are at much higher risk and would likely benefit from more intensive treatment, monitoring or outpatient follow up."

Congestive heart failure occurs when the heart can't pump enough blood to meet the demands of the body, resulting in heart enlargement and fluid swelling. It is most often caused by coronary artery disease, high blood pressure, heart valve disease and alcohol abuse. Roughly 5.7 million people in the United States have heart failure, which kills about 300,000 each year, and results in repeat hospitalizations for many patients. Readmission rates are a focus of efforts to reduce health care costs, Michtalik notes.

Michtalik and his colleagues studied 241 heart failure patients admitted to The Johns Hopkins Hospital between June 2006 and April 2007 who were treated with intravenous diuretics to remove fluid from the body.

Within the first 24 hours, blood was drawn from the patients and tested for NT-proBNP, and patients were treated for their symptoms by their individual doctors. Though the patients' NT-proBNP levels were tested again at discharge, the decision for or against discharge was determined by clinical judgment alone and the treating physicians were not aware of the protein's level at discharge.

Analysis showed that patients whose protein levels decreased by less than 50 percent over the course of the several days to a week that they were in the hospital were at the highest risk for readmission or death.

"Our research suggests that maybe clinical judgment isn't enough to decide whether a heart failure patient is ready to be discharged," he says. "These patients may benefit from being treated until the heart failure marker, NT-proBNP, decreases by a certain percentage, something that is not considered now."

Michtalik says a good next step would be a prospective randomized trial that examines whether hospitalized heart failure patients do better when their doctors work intensively to decrease the heart failure marker over the course of their hospital stays.


'/>"/>

Contact: Stephanie Desmon
sdesmon1@jhmi.edu
410-955-8665
Johns Hopkins Medical Institutions
Source:Eurekalert

Related medicine news :

1. Radio-guided surgery a safe and simple way to remove potentially cancerous nodules in the lung
2. Simple spit and blood tests might detect burnout before it happens
3. Quick, Simple Test Can Detect Concussion in Athletes
4. Toward a fast, simple test for detecting cholera rampaging in 40 countries
5. Simple feedback could be effective therapy for addictive behaviors
6. Simple Screen May Help Spot Depression in College Students
7. Wounded Congresswoman Responds to Simple Commands
8. Simple fingertip test may identify breast cancer patients at risk for carpal tunnel syndrome
9. Simple Travel Tips Can Help Keep Pets Safe
10. Simple tools help parents understand a childs risk of obesity, make positive changes
11. Simpler and cheaper antibiotic prophylaxis with insertion of nutrition catheter in the stomach
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... ... October 13, 2017 , ... The American Board of Family Medicine's ... President and Chief Executive Officer, succeeding Dr. James C. Puffer upon his retirement. Dr. ... 2018 until Dr. Puffer’s retirement at the end of 2018. Upon assuming the role ...
(Date:10/13/2017)... ... October 13, 2017 , ... Lori R. Somekh, founder of ... ElderCounsel, a national organization of elder law and special needs planning attorneys. “Membership in ... It also provides a forum to network with elder law attorneys nationwide,” said Somekh. ...
(Date:10/13/2017)... ... October 13, 2017 , ... Ellevate Network, the leading network for ... for action towards gender equality at their inaugural Summit in New York City in ... reached a social audience of over 3 million. To watch the Mobilize Women video, ...
(Date:10/13/2017)... ... 2017 , ... Coveros, a leader in agile coaching services ... by the Center for Medicare and Medicaid Services (CMS). The Enterprise Agile Transformation ... Agile methodologies in a consistent and high value manner across CMS programs. Coveros ...
(Date:10/12/2017)... ... 12, 2017 , ... CitiDent and San Francisco dentists, Dr. ... Oventus O2Vent technology. As many as 18 million Americans are estimated to suffer ... Oral appliances can offer significant relief to about 75 percent of people with ...
Breaking Medicine News(10 mins):
(Date:10/12/2017)... , Oct. 12, 2017 AVACEN Medical , ... company with their  2017 New Product Innovation Award for ... extensive primary and secondary medical device market research by Frost ... its first-to-market OTC, drug-free pain relief product, the AVACEN 100, ... to treating fibromyalgia widespread pain. ...
(Date:10/11/2017)... FRISCO, Texas , Oct. 11, 2017 /PRNewswire/ ... healthcare services, has amplified its effort during National ... patients about hereditary cancer risks. ... Journal of Clinical Oncology calculated that more than ... to have inherited mutations in BRCA1 or BRCA2 and ...
(Date:10/5/2017)... , Oct. 5, 2017  In response to ... Oral and Maxillofacial Surgeons (AAOMS) released prescribing recommendations ... to be used as a first-line therapy to ... Recognizing the value ... White Paper "Opioid Prescribing: Acute and Postoperative Pain ...
Breaking Medicine Technology: