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B-Type Natriuretic Peptide and Congestive Heart Failure

Congestive heart failure (CHF) is the most frequent cause of hospitalization of those age 65 and older and is the cause of 5% to 10% of all hospital admissions.1 As our population continues to live longer, CHF will add to hospitalization costs worldwide. In heart failure, regardless of the underlying etiology, fluids accumulate in the blood vessels of organs, causing congestion. Heart failure is associated with impaired ventricular function and can be either systolic or diastolic in nature. It may also be considered right-sided or left-sided. Patients who experience impaired left ventricular function typically have shortness of breath (dyspnea) because the lungs become congested. U.S. data indicates that heart failure is either the primary or secondary diagnosis in three million hospitalizations per year. ‘Frequent fliers’, those patients that visit emergency departments with great frequency, incur many of these hospitalizations. Thus, heart failure is associated with high readmission rates. According to the Centers for Medicare and Medicaid Services (CMS) costs associated with CHF outweigh those associated with cancer and myocardial infarction.2 Clinicians commonly classify CHF patients according to the characteristics described by the New York Heart Association (NYHA) rubric for CHF. These classes are based on how much physical activity will cause limitations to the patient (Table 1). NATRIURETIC PEPTIDES The natriuretic peptide system consists of four structurally similar natriuretic peptides that compensate for changes in volume and pressure by promoting the removal of Na+ ions from the blood. The atrial natriuretic peptide (ANP) was the first to be identified in… ABBREVIATIONS: ADL = activities of daily living; AMI = acute myocardial infarction; ANP = atrial natruivetio peptide; BNP = B-type natriuretic peptide; CHF = congestive heart failure.