skip to content

Follow Paul on his heart failure journey

Decorative Illustration

Living with heart failure can be challenging. Take Paul, he's 68 years old.

Acute heart failure

Paul is at home with his daughter, Anne, one day when, suddenly, he has an acute shortness of breath.

Decorative Illustration

These symptoms can be as painful and stressful as chest pain in heart attack.
In a panic and fearing for her father’s life, Paul’s daughter calls for an ambulance.

Thankfully, the ambulance comes quickly and takes Paul to the closest hospital’s emergency department.

Decorative Illustration

The emergency physician, Rachel, reassures Paul that she will find out what is happening and help him and his family through this traumatic time.

Rachel will asess heart failure probability before proceeding to further investigations, through Paul's clinical history, a physical examination and an electrocardiogram.1

Decorative Illustration

Rachel is looking for a comprehensive picture to make a decision on what the next steps for Paul's care should be:

Decorative Illustration

One element of the initial assessment is abnormal, that's why Rachel performs a NT-proBNP test in order to confirm the high likeliness of acute heart failure or to exclude it.2

Heart failure is unlikely. 1,2

The 2016 ESC Heart Failure Guidelines say, if NT-proBNP is lower than 300 pg/mL, heart failure is unlikely and echocardiography is not required.1 Another diagnosis needs to be considered.

Heart failure is likely. 2

The 2016 ESC Heart Failure Guidelines say, results equal or higher than 300 pg/mL, means that the patient needs further investigation to confirm the diagnosis of heart failure.1

The interpretation of the results depends on various factors, including the age of the patient.2

Decorative Illustration

NT-proBNP has age-specific cutoffs to improve the accuracy of the diagnosis.2

Paul’s result is high at 6,293 pg/mL.

Decorative Illustration

Therefore, Rachel does an echocardiography1 to confirm the diagnosis: Paul has acute heart failure.

Paul needs to be transferred to the cardiology department, where the appropriate treatment is started.

Decorative Illustration

Rajiv, the cardiologist, recommends that he will have to stay 5 - 10 days3 in the hospital until his status is more stable.

After 10 days, Paul is responding well to the treatment and is nearly ready to go home. To be sure that Paul is OK to be discharged, Rajiv performs another NT-proBNP test to see how well Paul's condition has stabilized.

Decorative Illustration

Paul's result is 2,909 pg/mL, which is a decrease of more than 30% compared to the admission results, and reflect a low risk for future cardiovascular adverse events. 4-6

As Paul has significantly improved, from now on he will be managed by a multidisciplinary team, including a nurse, general practitioner, cardiologist and other specialists who monitor Paul's clinical status and NT-proBNP.1

Decorative Illustration

As Paul has significantly improved, from now on he will be managed by a multidisciplinary team, including a nurse, general practitioner, cardiologist and other specialists who monitor Paul's clinical status and NT-proBNP.1

Monitoring NT-proBNP in out-patient setting provides an objective indication of Paul's disease status beyond symptoms which may not always be a reliable guide. 1,7

Decorative Illustration

Increasing NT-proBNP levels indicate that the patient's condition is worsening and that the risk of hospitalization or mortality is rising.1,7-9

Decorative Illustration

Decreasing NT-proBNP levels indicate that the patient's condition is improving. 1,8,9

Paul's result is 900 pg/mL and decreased in comparison to his results at the previous visit.

Changes in NT-proBNP levels strongly predict outcomes regardless of therapy. 1,7-10

Paul's NT-proBNP levels are decreasing and he shows no worsening symptoms of heart failure. His condition is improving 1,7-10 and he can get back to living his life.

Clinical assessment, plus NT-proBNP testing, helps physicians to make better decisions in heart failure management at every stage of care.

Chronic heart failure

Paul has been feeling unwell for some time and complains about a range of symptoms like . . .

Decorative Illustration

It's frustrating for Paul, as even simple tasks become more challenging, so he visits his general practitioner, John. From Paul's assessment, John can see a number of possible diagnosis, but thinks about heart failure.

Decorative Illustration

John will assess heart failure probability before proceeding to further investigations, through Paul's clinical history, a physical examination and if possible through an electrocardiogram.1

John is looking for a comprehensive picture to make a decision on what the next steps for Paul's care should be:

Decorative Illustration

One element of the initial assessment is abnormal, that's why John performs a NT-proBNP test in order to identify if the patient needs further investigation to confirm the diagnosis of heart failure.1

Heart failure is unlikely.1

Decorative Illustration
-The 2016 ESC Heart Failure Guidelines say, results lower than 125 pg/mL, means heart failure is unlikely and echocardiography is not required.¹ Another diagnosis needs to be considered.

Echocardiography required1

Decorative Illustration
The 2016 ESC Heart Failure Guidelines say, results equal or higher than 125 pg/mL, means the patient needs further investigation to confirm the diagnosis of heart failure.¹

Paul's result is high at 1,087 pg/mL. Therefore, an echocardiography¹ will be done to confirm the diagnosis: Paul has chronic heart failure.

Decorative Illustration

At first he feels anxious but he is reassured by his treatment and regular check-ups, where John monitors his clinical status and NT-proBNP.

Decorative Illustration

Monitoring NT-proBNP is out-patient setting provides an objective indication of Paul's disease status beyond symptoms, which may not be a reliable guide.1,7

Decorative Illustration

Increasing NT-proBNP levels indicate that the patient's condition is worsening and that the risk of hospitalization or mortality is rising.1,7-9

Decorative Illustration

Decreasing NT-proBNP levels indicate that the patient's condition is improving. 1,8,9

Paul's result is 469 pg/mL and decreased in comparison to his results at the previous visit.

Changes in NT-proBNP levels strongly predict outcomes regardless of therapy. 1,7-10

Paul's NT-proBNP levels are decreasing and he shows no worsening symptoms of heart failure. His condition is improving 1,7-10 and he can get back to living his life.

Clinical assessment, plus NT-proBNP testing, helps physicians to make better decisions in heart failure management at every stage of care.

References

  1. Ponikowski et al. (2016). Eur Heart J. 37(27), 2129-200

  2. Januzzi et al. (2006). Eur Heart J. 27, 330-337

  3. Cowie et al. (2014). ESC Heart Fail. 1(2):110-145

  4. Salah et al. (2014). Heart. 100(2):115-125

  5. Stienen et al. (2015). J Card Fail. 21(11):930-934

  6. Stienen et al. (2015). Eur J Heart Fail. 17(9):936-944

  7. Pellicori et al. (2017). Eur J Heart Fail. 19, 768–778

  8. Zile et al. (2016). J Am Coll Cardiol. 68(22):2425-2436

  9. Januzzi, J.L. Jr. (2016) Clin Chem. 62(5):663-5

  10. McKie and Burnett (2016). J Am Coll Cardiol. 68(22):2437-2439