A sky-high NT-proBNP on admission more often meant infection than heart failure

The edition in brief

Among 415 hospital admissions with NT-proBNP of 20 000 pg/mL or more, median age 82, infection was the primary diagnosis in 60% and heart failure in only 19%. Mortality was 43.6% in hospital and 64.5% at six months, highest in those with infection; older age and low albumin predicted death. The finding is observational but argues for looking for sepsis before attributing an extreme value to heart failure. In the CTEPH-DETECT quasi-cluster randomised trial, an electronic alert to clinicians of 400 symptomatic patients six months or more after pulmonary embolism raised echocardiography orders from 17.5% to 32.5% and detection of pulmonary hypertension from 5.0% to 10.5%, though no new chronic thromboembolic pulmonary hypertension was formally diagnosed. A Taiwanese non-randomised pilot of direct home admission for 144 frail older adults with acute infection showed similar remission and mortality to hospital care, shorter stays and higher satisfaction, with 10.8% needing transfer. The ASGARD feasibility trial of anakinra against intramuscular methylprednisolone for gout flares in chronic kidney disease recruited only 21 patients and cannot guide treatment. The pearl sets out flare treatment when the kidneys limit the options.