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NP predischarge thresholds associated with reduced ADHF mortality, readmission

November 28, 2016

1. Achieving NP predischarge thresholds is associated with reduced acute decompensated heart failure mortality and readmission
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Low-strength evidence suggests that achieving brain-type natriuretic peptide (BNP) and pro-brain-type natriuretic peptide (NT-proBNP) predischarge thresholds is associated with a reduced risk for mortality and readmission in patients with acute decompensated heart failure (ADHF). The systematic evidence review is published in Annals of Internal Medicine.

Nearly 1 million patients are hospitalized each year with ADHF and more than half of them are readmitted within 6 months with similar symptoms. Discharge decisions are often based on physical examination findings that tend to be imprecise, which may contribute to the high rate of readmissions. Guiding outpatient treatment using BNP and NT-proBNP levels has demonstrated effectiveness in meta-analyses but no corresponding meta-analyses has been done with regard to inpatient ADHF treatment.

Researchers performed a systematic review to examine the effect of using NP thresholds as a discharge criterion on readmission and mortality rates in patients hospitalized for ADHF. They identified 70 full-text articles addressing 10 distinct methods for evaluating readiness for discharge. While evidence was low-strength, the studies consistently showed a statistically significant reduction in all-cause and cardiovascular mortality and readmission when predischarge thresholds were achieved. More research is needed to determine definitively if discharge thresholds can be prospectively used to improve clinical outcomes.

2. Internists can play a role in helping young adults prioritize health care
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While young people aged 18 to 25 years may be chronological adults, their brain neural pathways are not yet completely matured. For most young adults, health care needs are out-ranked by other demands and priorities. And according to an article published in Annals of Internal Medicine, young adults are surprisingly unhealthy, with high rates of serious mental health conditions, unintentional injury, substance abuse, and sexually transmitted infections. Since these patients have "aged out" or pediatric care, internists can play an important role in helping them transition to adult care. In an ideal system, pediatric and adult care practices would work together to help this transition. But the authors say that the unique needs of emerging adults have not received the attention they deserve from either adult or pediatric clinicians. As such, the American College of Physicians (ACP) recently introduced guidelines and tools to help internists address the gaps that currently exist in the health care system for these patients.

American College of Physicians

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