Heart failure: Natriuretic peptide use in the hospital

Abstract

Acute decompensated heart failure (ADHF) is a leading cause of hospitalization amongst elderly in the U.S. The role of natriuretic peptides (NPs) is clear in the evaluation of acute dyspnea to help diagnose ADHF. NPs are quantitative markers of wall stress and reflect severity of heart failure. In the inpatient management of ADHF, serial sampling and recognition of down-trending NPs is a powerful indicator of patients who are at lower risk for future adverse events. Serial monitoring at least once during hospitalization (or if clinical uncertainty exists) and a pre- discharge NP should be checked to ensure patients are appropriate for discharge. If persistent elevation occurs, alternate etiologies for this should be considered and medications should be further up-titrated and optimized prior to discharge.