Dr Sim : NT-proBNP if done as the one-off reading, is not as useful as a serial reading. If somebody starts at a high reading, and if shown that on discharge and one month after discharge the value is coming down, then you can be assured that you are in the right direction. If just one reading on admission is high, it is difficult to ascertain the correct direction to head on. Especially in young patients, if the NT-proBNP values are very high at the outset and it doesn’t come down, in fact, it is showing an upward trend; It would probably result in further imaging study to confirm any CV abnormality and to confirm that medications have been optimised. These are the group for early consideration of CRT or even heart transplant or left ventricular assist device. Patients who starts at values of 5000 pg/mL and ends up, in few months, to a fewer than 5000 pg/mL are at a high risk of adverse CV events risk of dying and the risk of readmission is very high in the next 12 months.
Dr Januzzi : For hospitalised patients it is recommended to get a pre-discharge NT-proBNP to evaluate for in-hospital reduction of 30% or greater and then re-measure after one or two weeks in the office or in the home to ensure that the patient is continuing to improve.
