{
  "abstract": "Background The 2022 ACC/AHA/HFSA Heart Failure guidelines recommend reclassifying individuals from Stage A to Stage B if BNP ≥35 pg/mL or NT-proBNP ≥125 pg/mL, reflecting higher risk. However, the optimal BNP threshold for clinically meaningful risk remains uncertain.Objective To determine the optimum BNP threshold at which Stage A patients exhibit event burden comparable to those in Stage B.Methods We analysed 1,425 participants in the STOP-HF program with baseline BNP, echocardiography, and follow-up data. Participants were classified as Stage A or B at baseline and reassessed at follow-up (mean 5.4 years). Clinical events were grouped as acute decompensated heart failure events (ADHFE), non-HF cardiac events (NHFCE), and non-cardiac events (NCE). We applied BNP thresholds of ≥35, ≥50, ≥60, and ≥75 pg/mL to Stage A participants and compared adjusted event rates with those in Stage B.Results Of 1,425 patients, 67% were Stage A and 33% Stage B at baseline. ADHFE rates generally rose progressively with increasing BNP in Stage A. Further analysis demonstrated that total event rates between the two groups converged when the BNP threshold was increased to ≥75 pg/mL ( table 1). This finding raises important considerations regarding optimal BNP cutoffs for risk stratification and suggests that a higher threshold may better reflect the clinical event burden typically associated with Stage B HF.Conclusion A BNP threshold of ≥75 pg/mL more closely aligns Stage A patients with Stage B-level risk, offering a potentially more refined criterion for early HF risk stratification. These findings support revisiting current BNP cutoffs in prevention guidelines.Abstract 20 Table 1Association between increasing BNP thresholds in stage A heart failure and risk-adjusted clinical event rates compared to stage B",
  "authors": [
    {
      "affiliations": [
        "St Vincents University Hospital, Dublin, Ireland"
      ],
      "name": "A Moore"
    },
    {
      "affiliations": [
        "St Vincents University Hospital, Dublin, Ireland"
      ],
      "name": "M Barrett"
    },
    {
      "affiliations": [
        "St Vincents University Hospital, Dublin, Ireland"
      ],
      "name": "J Gallagher"
    },
    {
      "affiliations": [
        "St Vincents University Hospital, Dublin, Ireland"
      ],
      "name": "M Ledwidge"
    },
    {
      "affiliations": [
        "St Vincents University Hospital, Dublin, Ireland"
      ],
      "name": "K McDonald"
    }
  ],
  "title": "20 Beyond the threshold: what BNP is really telling us about stage a heart failure",
  "uid": "4e37ec0d-161e-5d54-b95a-a0dc8affa508"
}