Page 90 - Biomarkers for risk stratification and guidance in heart failure

Which heart failure patients profit from natriuretic peptide-guided therapy?
The influence of comorbidities on the response to (NT-pro)BNP-guided therapy with respect to HF admissions was considerably less than for mortality. For this end-point, no statistically significant interaction between comorbidities and the efficacy of (NT-pro)BNP-guided treatment was found in either HFrEF or HFpEF. The hazard ratios for HF admission on (NT-pro)BNP-guided therapy compared with clinically-guided management according to comorbidities are given in the Supplementary tables, Table S1; Table S2 gives an overview of the number of patients included in each subgroup and the number of events.
Influence of age on (N-terminal pro-)brain natriuretic peptide-guided
therapy
The previously described interaction between age and treatment strategy
allocation on mortality was confirmed in the current analysis. Thus in HFrEF 4 patients, the beneficial effect was mainly seen in patients aged <75 years (HR =
0.68, 95% CI 0.48 - 0.96, P = 0.03; n = 881), but not in those aged ≥75 years (HR = 0.87, 95% CI 0.65 - 1.16, P = 0.35; n = 850; interaction P = 0.22). In HFpEF patients aged <75 years, NT-proBNP-guided therapy resulted in a HR of 0.76 (95% CI 0.29 - 1.96, P = 0.56; n = 96), whereas in those aged ≥75 years the HR was 1.56 (95% CI 0.90 - 2.70, P = 0.11; n = 200; interaction P = 0.02). The interaction between age and treatment efficacy disappeared when interactions between comorbidities and treatment strategy allocation were considered (Table 3), whereas the interactions between comorbidities and treatment efficacy were not influenced by age. Thus in patients with HFpEF, the effect of age on treatment response was no longer apparent when additional interactions with renal failure or the combination of CVI, diabetes mellitus, and COPD were considered. In patients with HFrEF, the presence of one of the following four comorbidities explained the potential influence of age: CVI/TIA, diabetes, COPD, or PVD. In both HFpEF and HFrEF, the benefit of (NT-pro)BNP-guided therapy was greater in patients with hypertension, independently of the interaction with age.
Age had little impact upon the effect of (NT-pro)BNP-guided therapy upon HF admissions in either patient group (both interactions P > 0.30).
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