Aims Our purpose was to investigate the association between the B‐type natriuretic peptide (BNP) level at discharge, the occurrence of worsening renal function (WRF), and long‐term outcomes in patients with heart failure (HF). Methods and results We enrolled hospitalized acute HF patients. We divided patients into four groups on the basis of BNP 250?pg/mL (BNP?) or BNP ≥250?pg/mL (BNP+) at discharge and the occurrence of WRF during admission: BNP?/WRF?, BNP?/WRF+, BNP+/WRF?, and BNP+/WRF+. We evaluated the association between BNP at discharge, WRF, and cardiovascular/all‐cause mortality/hospitalization due to HF. Clinical follow‐up was completed in 301 patients. At discharge, percentages of the patients with clinical signs of HF were low and similar among four groups. The median follow‐up period was 1206?days (interquartile range, 733–1825?days). The composite endpoint of cardiovascular mortality and HF hospitalization was significantly different between the four groups [12.9% (BNP?/WRF?), 22.7% (BNP?/WRF+), 35.8% (BNP+/WRF?), and 55.4% (BNP+/WRF+), P??0.0001]. All‐cause mortality was also different etween the four groups (15.1%, 38.6%, 28.7%, and 39.3%, respectively, P?=?0.003). In the multivariate Cox proportional hazards model, the combination of BNP ≥250?pg/mL and WRF showed the highest hazard ratio (HR) for composite endpoint (HR, 5.201; 95% confidence interval, 2.582–11.11; P??0.0001), and BNP?/WRF+ was associated with increased all‐cause mortality (HR, 2.286; 95% confidence interval, 1.089–4.875; P?=?0.03). Patients in BNP+/WRF+ had a higher cardiovascular mortality (28.6%), and those in BNP?/WRF+ had a high non‐cardiovascular mortality (29.5%). Conclusions Heart failure patients with BNP ≥250?pg/mL at discharge and in‐hospital occurrence of WRF had the highest risk for the composite endpoint (cardiovascular mortality and HF hospitalization) among groups.
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