{
  "abstract": "Background In Stage A heart failure (HF) routine natriuretic peptide (NP) monitoring has been proposed despite limited empirical support. Recent ESC guidance suggests NP sampling every 6–12 months, but acknowledges the recommendation is based more on judgment than data.Objective To assess BNP trajectories over time in Stage A HF patients and evaluate the necessity of frequent biomarker surveillance.Methods We retrospectively analysed clinical, echocardiographic, and serial BNP data for 1,425 participants in the STOP-HF program. Patients were staged at baseline and reclassified over time. Serial BNP measurements were obtained at median intervals of 18.5, 32.2, and 49.1 months.Results The Stage A population comprised 913 individuals (median age 63 years [SD ±10]; 55% female). Baseline median BNP was 15 pg/mL. Based on progression, patients were categorised as A-A (non-progressors; n=731) or A-B/C (progressors; n=228), with 94% of progressors advancing to Stage B and 6% to Stage C. Median BNP levels rose over time in both groups. By 18.5 months, the A-A group showed an 18% increase (+2 pg/mL) versus a 19% increase (+5 pg/mL) in A-B/C. By 32.2 months, increases reached 42% (+5 pg/mL) and 69% (+18 pg/mL), respectively. At 49.1 months, median BNP had risen by 73% (+9 pg/mL) in A-A and 102% (+27 pg/mL) in A-B/C. Notably, only seven Stage A patients with baseline BNP <35 pg/mL exceeded this threshold by the first interval at 18.5 months.Conclusions BNP levels in Stage A patients show only slight increases over time, likely within normal biological variation. Short-term progression to Stage B or C is uncommon, suggesting that extending HF assessment intervals to at least three years may be reasonable, barring significant clinical change. This supports a more measured interpretation of recent ESC guidelines.",
  "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": "38 Small rises, big questions – rethinking BNP surveillance in preclinical heart failure",
  "uid": "9d7a2a32-eba7-5a0b-9c91-212c6641808d"
}