In brief, patients in the high bio-ADM group were higher age (75 (67–81) year-old vs. 56 (52–67) year-old, p < 0.001), had higher CardShock risk score (5 (4–7) vs. 4 (3–4), p = 0.003), had lower diastolic arterial pressure (55 (46–61) mmHg vs. 60 (55–69) mmHg, p = 0.045), had lower estimated glomerular filtration rate (eGFR) (39.8 (31.1–49.0) mL/min/1.73 m2 vs. 69.5 (53.3–90.5) mL/min/1.73 m2, p < 0.001), had higher NT-proBNP (7543 (4427–20,766) pg/mL vs. 702 (375–1782) pg/mL, p < 0.001), and had higher occurrence of refractory CS (34% vs. 7%, p = 0.021). Here, NPPB is linked to Cowden syndrome 1.