High BNP predicts stroke or systemic embolism in very elderly NVAF patients

22 May 2022
High BNP predicts stroke or systemic embolism in very elderly NVAF patients

In very elderly nonvalvular atrial fibrillation (NVAF) patients who are ineligible for standard anticoagulation, increasing levels of B-type natriuretic peptide (BNP) appear to be correlated with higher risks of stroke or systemic embolism (SSE), reports a new study.

Conducting a subanalysis of the ELDERCARE-AF trial, the researchers enrolled 984 patients (mean age 86.6 years), of whom 428, 300, and 256 were deemed to have low (<200 pg/mL), moderate (200–<400 pg/mL), or high (≥400 pg/mL) BNP, as measured by chemiluminescence enzyme immunoassays.

SSE developed in seven patients in the low BNP group, yielding an incidence rate of 1.2 percent. This increased progressively in the moderate (n=24; 5.9 percent) and high (n=28; 8.6 percent) BNP subgroups.

Cox proportional hazards analysis, adjusted for potential confounders, revealed that SSEs were significantly more likely to develop in those with moderate vs low BNP (adjusted hazard ratio [HR], 3.82, 95 percent confidence interval [CI], 1.60–9.12; p=0.0025). A similar and stronger effect was reported among those with high vs low BNP, in whom SSE risk was nearly five times higher (adjusted HR, 4.76, 95 percent CI, 1.93–11.76; p=0.0007).

Strokes were likewise significantly more likely to arise in those with moderate (adjusted HR, 3.30, 95 percent CI, 1.35–8.08; p=0.0089) and high (adjusted HR, 4.86, 95 percent CI, 1.94–12.18; p=0.007) vs low BNP.

In contrast, no among-group differences were reported for safety outcomes such as major bleeding, intracranial haemorrhage, and gastrointestinal bleeding.

Editor's Recommendations