A new prognostic index (BASIC) combining B-type natriuretic peptide with age, sodium, hemoglobin, and kidney function significantly outperformed BNP alone in predicting death in 1,065 heart failure patients, with scores above 9.3 indicating nearly 3-fold higher mortality risk.
HR 2.70 above cut-off 9.3Heart failure patients with a BASIC index score above 9.3 had 2.7 times the risk of death compared to those below this threshold, significantly outperforming BNP alone as a prognostic marker.
What the researchers found
The BASIC index formula — BNP × age² / (sodium × hemoglobin × eGFR) — was evaluated in 1,065 chronic heart failure outpatients with systolic dysfunction followed for a median of 47 months.
Key results:
- AUC: 0.73 (0.70-0.76) vs. 0.69 (0.66-0.72) for BNP alone (p < 0.001)
- Optimal cut-off: 9.3 (sensitivity 71.4%, specificity 62.3%, PPV 66.5%, NPV 67.5%)
- Patients with BASIC index > 9.3: adjusted hazard ratio for all-cause mortality = 2.70 (95% CI: 2.20-3.22)
- During follow-up, 545 of 1,065 patients (51.2%) died
- Median BASIC index: 11.7 (IQR: 3.5-33.7)
Why it matters
BNP is the most widely used peptide biomarker in heart failure, but alone it has limited prognostic accuracy. By combining BNP with four other readily available clinical values into a single number, the BASIC index provides a more complete picture of patient risk without requiring any additional testing. This could help clinicians identify high-risk patients who need more aggressive treatment, closer monitoring, or earlier referral for advanced therapies like heart transplant or mechanical support devices.
How the study worked
This was a retrospective cohort study of adult outpatients with chronic heart failure and systolic dysfunction followed at a single center from January 2012 to December 2020, with follow-up until January 2023. The BASIC index was calculated from five parameters measured at the index (baseline) visit. The primary endpoint was all-cause mortality. Receiver operating characteristic (ROC) curve analysis compared the index's predictive performance against BNP alone. Cox regression with multivariate adjustment for established prognostic predictors assessed independent prognostic value.
What this study cannot tell us
This is a single-center retrospective study, which limits generalizability. The index has not been validated in an independent external cohort. The AUC improvement from 0.69 to 0.73, while statistically significant, is modest. The formula includes BNP (not NT-proBNP, a related but different assay), so applicability to centers using NT-proBNP needs evaluation. The study population was primarily elderly (mean age 71) and predominantly male (65.8%), which may not represent all heart failure populations. The index does not account for medications or ejection fraction.
How to read the evidence
This is a retrospective cohort study with a substantial sample size (1,065 patients) and long follow-up (median 47 months). The statistical analysis includes multivariate adjustment and comparison against the established BNP biomarker. However, it is single-center, retrospective, and lacks external validation, placing it at a moderate evidence level.
When this study was published
Published in 2025, this is a very recent study proposing a novel application of the BNP peptide biomarker in a composite prognostic index for heart failure.
The bigger picture
B-type natriuretic peptide (BNP) is a peptide hormone released by heart muscle cells under stress and is the cornerstone biomarker for heart failure diagnosis and monitoring. This study demonstrates that BNP's prognostic value can be significantly enhanced by contextualizing it with other clinical data. The approach reflects a growing trend in precision medicine: combining biomarkers into composite indices that capture the multisystem nature of heart failure, which affects not just the heart but also the kidneys, blood, and overall metabolic state.
Questions still open
- Does the BASIC index perform similarly in heart failure with preserved ejection fraction (HFpEF)?
- Can the formula be adapted for NT-proBNP, which is more commonly used in some healthcare systems?
- Would serial BASIC index measurements over time improve prognostic accuracy beyond a single baseline calculation?
Common questions
What is BNP and why is it important in heart failure?
How is the BASIC index calculated and what does a high score mean?
Read the original research
A new simple chronic heart failure prognostic index based on five general parameters.
International journal of cardiology, 423, 133002
Citation
Hipólito-Reis, Helena; Guimarães, Carolina; Elias, Catarina; Gouveia, Rita; Madureira, Sérgio; Reis, Catarina; Fonseca, Ana Margarida; Grijó, Carlos; Neves, Ana; Matos, Mariana; Rocha, Helena; Almeida, Jorge; Lourenço, Patrícia. (2025). A new simple chronic heart failure prognostic index based on five general parameters.. International journal of cardiology, 423, 133002. https://doi.org/10.1016/j.ijcard.2025.133002