Page 58 - Biomarkers for risk stratification and guidance in heart failure

Management of chronic heart failure guided by individual NT-proBNP targets.
Figure 3. Overall survival by treatment group.
NT-proBNP levels and use of medication.
After 1-year follow-up, 80% of patients were at or below their individual target level. In 23% of all outpatient visits, NT-proBNP levels were above the individualized target level. In 79% of all outpatient visits with an off-target NT-proBNP level, protocol adherent action was undertaken (Table 3). Evidence-based medication for HF was extensively used in both groups (Table 4). Renin-angiotensin inhibition was used significantly more frequently after 1 year in the NT-proBNP-guided group. Management guided by an individualized NT-proBNP target also led to an overall increased use of HF medication (Table 5). An increased NT-proBNP value most often prompted physicians to intensify diuretic therapy (Table 3). The lack of significant beneficial outcomes suggests that intensifying diuretic therapy may not be adequate to prevent events. We therefore compared the effects of intensifying evidence-based HF medication (i.e., increase renin-angiotensin system blockade, beta-blockade, and spironolactone) to the effect of intensifying diuretics in response to an increased NT-proBNP level. However, no differences were found between the 2 types of treatment in their ability to get more patients on or below target level at the next outpatient follow-up (40% vs. 33%, p= 0.369). Moreover, in general, intensifying HF medication (evidence-based HF medication or diuretics) compared with no pharmacological HF intervention was not associated with a
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