Page 156 - Biomarkers for risk stratification and guidance in heart failure

General Discussion
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1° EP
CV mort,
HF mort, HF hosp
All-cause mort, all-cause hosp
All-cause mort
All-cause mort, HF hosp.
Days alive without CV hosp
Days alive outside hospital
Days alive outside hospital
CEP mort, hosp, worsening HF
CV events
CEP mort, CV hosp
1° Effect
Effect mortality
Pos
Pos
7 vs 11, p=n.s.
Neg
Neg
Pos
Neg Neg
Neg Neg
Neg Neg
Neg Neg
Pos Neg
Neg Neg
(NT-pro)BNP ↓
↓ BNP in BNP group
↓ BNP in BNP group
↓ BNP in both groups
↓ BNP in BM and IC
↓ BNP in BM and IC, not in UC
Modest ↓ BNP both groups ~10%
↓ BNP in both groups
No difference in final BNP levels
-
↓ BNP in BNP group
Modest ↓ BNP both groups
Target reached (%)
-
33% at 3 months
<50% at 6 months
<50% at 24 months
-
19%
80% at 1 year
68%
-
44%
-
CV hosp , outpatient HF
1 vs 7, p=0.06
Trend pos, p=0.06
Neg (BM vs IC)
Neg (BM vs IC)
Inter. Age - - Yes Yes No - N.S. - No No No Inter. LVEF - - Yes - - - - - - - -
Other
Betablocker used in only 7% of pts.
Already on optimized HF treatment at randomisa- tion.
Survival Survival benefit in benefit in patients patients < 75 years < 75 years
Higher mortality UC vs IC/BM
Study performed in primary care setting
Excluded pt without initial ↓NT- proBNP
Pilot study
Respond- ers (↓BNP > 30%) had lower mortality
More
Already on optimized HF treat- ment at randomisa- tion.
NT-proBNP = n-terminal pro B-type natriuretic peptide; BNP = brain natriuretic peptide; incl = inclusion; adm = admission; UC = usual care; IC = intensified care;
CS = congestion score; LVEF = left ventricular ejection fraction; CT-ratio = Cor/thorax ratio; isch. = ischemic; HF = heart failure; ACE = aniotensin converting enzyme inhibitor; ARB = angiotensin receptor blocker; β-block = beta blocker; MRA = mineralocorticoid receptor antagonist; FU = follow-up; 1° = primary ; EP = endpoint; CV = cardiovascular; mort = mortality; hosp = hospitalization; CEP = composite endpoint; BM = (NT-pro)BNP-guided; BNP group = (NT-pro)BNP-guided; inter. = interaction * Different cutoffs for younger and more elderly-subjects
† (NT-pro)BNP-guided group versus clinically-guided group.
‡ NT-proBNP-guided versus IC.
§ More patients treated with triple therapy in NT-proBNP-guided group versus IC group.
‖ NT-proBNP-guided group compared to usual care
visits in BNP group