IIa B-NR During a HF hospitalization, a predischarge natriuretic peptide level can be useful to establish a postdischarge prognosis.93,96,104 113 NEW: Current recommendation reflects new observational studies. See Online Data Supplements A and B. Predischarge natriuretic peptide biomarker levels and the relative change in levels during hospital treatment are strong predictors of the risk of death or hospital readmission for HF.93,96,104 113 Several studies have suggested that predischarge natriuretic peptide biomarker levels had higher reclassification and discrimination value than clinical variables in predicting outcomes.96,106,108 111 Patients with higher predischarge levels and patients who do not have a decrease in natriuretic peptide biomarker levels during hospitalization have worse outcomes.96,106,108 111 Although observational or retrospective studies have suggested that patients with natriuretic peptide biomarker reduction had better outcomes than those without any changes or with a biomarker rise,93,107,112,113 targeting a certain threshold, value, or relative change in these biomarker levels during hospitalization may not be practical or safe for every patient and has not been tested in a prospective large-scale trial. Clinical assessment and adherence to GDMT should be the emphasis, and the prognostic value of a predischarge value or relative changes does not imply the necessity for serial and repeated biomarker measurements during hospitalization. IIb B-NR In patients with chronic HF, measurement of other clinically available tests, such as biomarkers of myocardial injury or fibrosis, may be considered for additive risk stratification.27,95,98,99,103,114 119 MODIFIED: 2013 recommendations have been combined into prognosis section, resulting in LOE change from A to B-NR. 