Natriuretic peptides are integral in reclassifying heart failure stage and risk.

We investigated the usefulness of B-type natriuretic peptides (BNP) and N-terminal pro-BNP (NT-proBNP) in reclassifying individuals from Stage A heart failure (at risk of HF) to Stage B HF (pre-HF) using a database of global electronic healthcare records. Individuals with Stage A HF, defined as having at least one risk factor for HF (hypertension, atherosclerotic cardiovascular disease, diabetes mellitus, or obesity), and clinically measured BNP or NT-proBNP between 2010 and 2019 were analyzed retrospectively. The cut-offs for reclassifying Stage A to B HF were 35 pg/mL for BNP and 125 pg/mL for NT-proBNP. The risk for the composite outcome of death or new-onset HF within five years was analyzed using Cox regression. Among 208,753 Stage A individuals with BNP values, 36% were reclassified as Stage B by BNP ≥ 35 pg/ml. Reclassified Stage B had a higher risk of the composite outcome than those who remained in Stage A (hazard ratio [HR] 1.93 [1.89–1.98], p < 0.001). Similarly, 32% of 87,596 individuals were reclassified as Stage B by NT-proBNP ≥ 125 pg/mL and had a higher risk of the composite outcome (HR 2.12 [2.05–2.19], p < 0.001). These findings were consistent across the co-morbid risk factors for HF and in a contemporary era (2018 to 2019). The risk of composite outcome increased step-wise with higher NP values, even at values below the HF diagnostic cut-offs. NPs can identify individuals at greater risk for incident symptomatic HF and should be measured in individuals with Stage A HF.