Natriuretic response as a marker of decongestion in hospitalized patients with heart failure

Background / Introduction

Optimal decongestion is central to the management of decompensated heart failure (HF), yet objective confirmation of adequate decongestion remains challenging. Reduction in NT-proBNP can reflect hemodynamic unloading and improvement in congestion. The relationship between achievement of protocol-defined natriuretic targets and NT-proBNP response in routine inpatient care remains unclear.

Purpose

To evaluate whether achieving natriuretic targets (response goal ≥100) is associated with meaningful biochemical decongestion in hospitalized HF.

Methods

We performed a retrospective analysis of consecutive HF admissions managed using a pharmacy-driven, natriuresis-guided diuretic protocol at a tertiary care center (N = 162). Achievement of a natriuretic response goal ≥100 was assessed during hospitalization. Decongestion was evaluated using paired NT-proBNP measurements when available. Outcomes included percentage NT-proBNP reduction, responder rates (≥50% NT-proBNP reduction), length of stay (LOS), and 30-day readmissions. Continuous outcomes were compared using non-parametric tests, and categorical outcomes using Fisher’s exact test.

Results

Among patients with paired NT-proBNP measurements (N = 37), median NT-proBNP levels decreased from 4,484 pg/mL to 2,430 pg/mL, corresponding to a median relative reduction of 42.3%. Patients achieving a natriuretic response goal ≥100 demonstrated a significantly greater percentage NT-proBNP reduction compared with those below this threshold (p = 0.02). Achievement of a natriuretic response ≥100 was also associated with a higher likelihood of decongestion, with 100% achieving ≥50% NT-proBNP reduction compared with 33.3% among those below the threshold (p = 0.01).

Median LOS was similar between groups (6 vs 5 days; p = 0.34). All-cause 30-day readmission rates did not differ (p = 0.64). Among patients with available HF-specific 30-day readmission data (n=07), the 30-day HF readmission rate was 13.4% (13/97) and was numerically higher among those achieving natriuretic goals (5/24 [20.8%] vs 7/72 [9.7%]; p = 0.17).

Conclusion(s)

In hospitalized HF, achievement of a natriuretic response goal ≥100 is associated with robust biochemical decongestion, reflected by greater NT-proBNP reductions and higher rates of ≥50% response. However, Natriuretic target attainment was not associated with longer hospital stay or HF-specific readmissions. These findings support natriuretic targets as practical markers of effective inpatient decongestion.