Heart failure (HF) and reduced ejection fraction patients with atrial fibrillation (AF) had higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) compared to those without AF, a recent study found. However, the study also found that above a concentration of 400 pg/mL, which represented most patients in each group, NT-proBNP had similar predictive value for adverse cardiovascular (CV) outcomes, irrespective of AF status. The study included 14,737 patients with HF and reduced ejection fraction and a measurement of NT-proBNP at time of screening enrolled in either the PARADIGM-HF trial or the ATMOSPHERE trial, of whom 3,575 (24%) had AF at baseline ECG. Patients with and without AF were categorized into 5 NT-proBNP bands: <400, 400 to 999 (reference), 1,000 to 1,999, 2,000 to 2,999, and ≥3,000 pg/mL. Researchers found:

• For the primary composite outcome of CV death or HF hospitalization, event rates differed for patients with and without AF in the lowest band (<400 pg/mL; 8.2 vs 5.0 per 100 patient-years), but not for the higher bands.
• These findings were consistent whether NT-proBNP was examined as a categorical or continuous variable and before and after adjustment for other prognostic variables.
• Similar results were observed for the components of the composite outcome and all-cause mortality.