Page 153 - Biomarkers for risk stratification and guidance in heart failure

Chapter 7
Figure 1. Seven major classes of biomarkers contributing to the biomarker profile in HF. Adapted from103 with permission from dr. E. Braunwald.
7.2 GUIDED THERAPY OF HEART FAILURE: THE PRIMA STUDY IN PERSPECTIVE.
The PRIMA study, a multicenter randomized investigator initiated study, addressed whether therapy of chronic heart failure guided by an individualized NT-proBNP target improves outcome (chapter 3 of this thesis). 345 Patients where randomized to heart failure therapy guided by an individually set NT-proBNP target level in addition to clinical signs, or by clinical signs alone. The individually set NT-proBNP target level was defined as the lowest NT-proBNP concentration at hospital discharge or 2 weeks follow-up. PRIMA demonstrated that selective intensification by an individualized NT-proBNP target did not significantly improve any of the pre-specified primary or secondary outcome measures. Although treatment guided by an individualized NT-proBNP target slightly improved the number of days alive outside the hospital and overall mortality, these changes were not statistically significant. Interestingly, a trend was seen towards improved outcome by NT-proBNP-guided therapy in patients with age < 75 years, HF with reduced left ventricular ejection fraction (HFrEF) and patient with preserved renal function (table 2 Chapter 3).
Until today many studies assessing the effect of natriuretic peptide (NP)-guided therapy have been published.44-56 Inclusion criteria, population size, treatment target, treatment response, and outcome measures were quite diverse among the studies (table 1). None of these studies demonstrated mortality reduction in the overall population, although two studies demonstrated a significant
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