News:NT-proBNP Guided vs. Sympton-Guided Heart Failure Therapy
NT-pro BNP Guided vs. Symptom-Guided Heart Failure Therapy By Michael W Tempelhof, MD
B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) have been validated as prognostic and diagnostic markers for patients with congestive heart failure. Previous studies which were limited in both study design and size, have precluded sound establishment for BNP and/or NT-proBNP as clinical markers to response of outpatient therapy for heart failure patients.
STUDY OBJECTIVE:
To compare 18-month outcomes of N-terminal BNP–guided vs symptom-guided heart failure therapy.
STUDY DESIGN and METHODS:
This investigation (TIME-CHF) enrolled 499 outpatients aged ≥60 with systolic heart failure, ≥NYHA class 2 heart failure symptoms, an LVEF ≤45%, hospitalization for heart failure within the preceding 12 months, and an NT-proBNP level ≥400 pg/mL for those <75 years old and ≥800 pg/mL for patients ≥75 years of age despite medical therapy. Patients were randomized to receive medical intervention dictated by clinical symptoms or by NT-proBNP levels with titration of medical therapy to reduce symptoms to <YHA class of II and BNP level of 2 times or less the upper limit of normal for the BNP-guided therapy study arm.
OUTCOMES:
Primary outcomes were 18-month survivalfree of all-cause hospitalizations and quality of life. Secondary outcomes of survival free of heart failure–related hospitalization.
RESULTS:
- BNP-guided patients had higher rates of protocol-recommended medication uptitration, received higher doses of both classes of medication, and were more likely to receive aldosterone antagonists than those in the symptom-guided group.
- No significant difference was found in the primary endpoints of survival free rates of hospitalization for any cause; HR (95% CI)., 0.91 (0.72-1.14) p=0.39
- Survival free of heart failure related hospitalization was significantly higher in the BNP-guided group than in the symptom-guided group: HR (95% CI)., 0.68 (0.50-0.92) p=.01.
CONCLUSIONS:
Utilization of NT-pro BNP levels to guide heart failure medical therapy intervention did not significantly improve overall; 18-month survival free of any hospitalizations or improve the quality of life more than in patients receiving standard symptom guided medical therapy.
Pfisterer M et al. BNP-guided vs symptom-guided heart failure therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME-CHF) randomized trial. JAMA 2009 Jan 28; 301:383.
Source
http://jama.ama-assn.org/cgi/content/full/301/4/383