The Potential Role of Natriuretic Peptide–Guided Management for Patients Hospitalized for Heart Failure

• Post-discharge outcomes following hospitalization for heart failure remain poor despite use of contemporary therapies.
• Objective methods are needed to inform necessity for admission, readiness for discharge, and optimization of therapy.
• Natriuretic peptides are useful across the spectrum of acute heart failure settings, ranging from the emergency department, inpatient stay, and post-discharge follow-up.
• Natriuretic peptides discriminate risk better than physician impression and should be consistently used in conjunction with clinical assessment.
• Natriuretic peptides represent a practical and important method for optimizing inpatient and post-discharge follow-up management for patients hospitalized with heart failure that requires continuing prospective study.

There are >1 million hospitalizations for heart failure (HF) in the United States annually. After discharge, 25% of these patients are rehospitalized within 30 days, and 30% are dead within 1 year. To date, all trials in patients with acute HF (AHF) have failed to improve post-discharge outcomes. There remains a need for an effective objective risk stratification strategy that is capable of reliably identifying patients at heightened risk for readmission and informing discharge decision making. Natriuretic peptide (NP) levels during and after AHF hospitalization can provide valuable information regarding congestion status and chronic remodeling stress. The lack of sensitivity and inter-rater reliability of physical examination, and failure to achieve dry weight in many patients before discharge, renders the use of NP to guide therapy to prevent readmission an attractive option. NP levels can be used across the spectrum of AHF care settings, ranging from the emergency department and inpatient stay to post-discharge follow-up and chronic management. This review summarizes available data and provides an expert opinion on the potential role of NPs to reduce HF readmissions.