{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T21:44:48Z","timestamp":1769118288155,"version":"3.49.0"},"reference-count":39,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Residual congestion (RC) at discharge predicts adverse outcomes in heart failure with reduced ejection fraction (HFrEF). Its impact on the implementation of guideline-directed medical therapies (GDMT) remains unclear. N-terminal pro-B-type natriuretic peptide (NT-proBNP) trajectory during hospitalisation reflects RC and may be associated with GDMT implementation. The aim was to assess whether discharge NT-proBNP and a fall in NT-proBNP &lt; 30% during hospitalisation (\u0394NT-proBNP &lt; 30%) predict GDMT underuse in acute HFrEF. In this prospective observational study, NT-proBNP was measured at hospital admission and 48\u201372 h before discharge. Provision of individual GDMT drug classes was assessed and GDMT underuse was defined as prescription of &lt;3 key GDMT drug classes at discharge. 391 HFrEF patients (mean age, 69.9 \u00b1 13.1years, 67.3% male) were included. \u0394NT-proBNP &lt; 30% was identified in 108 (27.6%). Higher discharge NT-proBNP was independently associated with lower likelihood of prescribing ACE-inhibitors, sacubitril\/valsartan, eplerenone\/spironolactone, or empagliflozin\/dapagliflozin. \u0394NT-proBNP &lt; 30% was associated with 17% higher odds of GDMT underuse (95% confidence interval, 1.10\u20131.31, p &lt; 0.001), regardless of clinical characteristics or in-hospital management. Patients with \u0394NT-proBNP &lt; 30% were discharged on lower doses of titratable GDMT medications. In-hospital NT-proBNP burden and trajectory, as markers of RC, are associated with GDMT underutilisation at discharge in acute HFrEF. Addressing RC may impact treatment quality in acute HFrEF.<\/jats:p>","DOI":"10.3390\/ijms27021028","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T14:57:58Z","timestamp":1768921078000},"page":"1028","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Predischarge NT-proBNP on Treatment Optimisation in Acute Heart Failure"],"prefix":"10.3390","volume":"27","author":[{"given":"Marija","family":"Polovina","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milenko","family":"Tomi\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milica","family":"Jankovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danka","family":"Civri\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Stoji\u0107evi\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Stankovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teodora","family":"Pejovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3470-7990","authenticated-orcid":false,"given":"Mihajlo","family":"Viduljevi\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4849-7031","authenticated-orcid":false,"given":"Gordana","family":"Krljanac","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milika","family":"A\u0161anin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0890-535X","authenticated-orcid":false,"given":"Sanja","family":"Stankovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"},{"name":"Center for Medical Biochemistry, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petar M.","family":"Seferovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Serbian Academy of Sciences and Arts, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1002\/ejhf.3710","article-title":"Insights into the European heart failure epidemiology","volume":"27","author":"Polovina","year":"2025","journal-title":"Eur. 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