Page 14 - Biomarkers for risk stratification and guidance in heart failure

As no treatment for HFpEF has proven to affect morbidity and mortality, treatment 1 is limited to the treatment of underlying diseases like hypertension, diabetes and
atrial fibrillation.1
Since most patients included in the large randomized therapeutic trials which underpin treatment guidelines were not truly elderly, had few comorbidities and had HFrEF, the findings from these trials might be less applicable to the majority of elderly patients seen in clinical practice.42 Therefore, a clear-cut treatment algorithm of HF is lacking in elderly.
Knowledge of factors associated with successful natriuretic peptide-guided therapy might help selecting those patients that profit the most from natriuretic peptide-guided treatment.
Guided therapy of heart failure: The importance of serial NT-proBNP measurements during and early after admission because of acute heart failure. Cornerstone of natriuretic peptide-guided therapy of HF is the identification of those patients at highest risk for events. As mentioned before, especially in patients discharged after admission because of acute HF, risk for events is high. Therefore, post-discharge risk stratification is important as it may help to identify those patients in need for intensive outpatient monitoring and (natriuretic peptide-guided) treatment. Natriuretic peptides might be helpful in this regard. In acute HF, both pre-discharge (NT-pro)BNP concentration and decrease in NT-proBNP during hospital admission are related to outcome after hospital discharge.43,44 Also in chronic HF, not only one single measurement of natriuretic peptides reflects risk, but variation in natriuretic peptides adds to prognostic assessment as well.45
However the prognostic value of change in NT-proBNP concentration one month after admission because of acute HF has not yet been evaluated. Furthermore, the incremental prognostic value of serial NT-proBNP measurements during admission and at early after hospital discharge has not yet been assessed. Knowledge of this incremental value might not only lead to a more accurate early outpatient risk assessment; it also gives clinicians a clue how to interpret early outpatient NT-proBNP levels: should we mainly focus on the absolute level, or should we take into account whether levels are decreasing or increasing?
Introduction
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