Page 92 - Biomarkers for risk stratification and guidance in heart failure

Which heart failure patients profit from natriuretic peptide-guided therapy?
BNP-guided ←→ control BNP-guided ←→ control 4 better better better better
Figure 3 Univariable hazard ratios (HR) on mortality with 95% confidence intervals of (N-terminal pro-) brain natriuretic peptide (NT-proBNP)-guided therapy compared with control group depending on presence (yes) or absence (no) of various comorbidities in patients with heart failure with reduced ejection fraction (HFrEF) (left) and heart failure with preserved ejection fraction (HFpEF) (right). ‘Overall’ refers to all patients irrespective of the presence or absence of comorbidities. HR <1.0 indicates beneficial effects of (NT-pro)BNP-guided therapy.
Table 3 Level of significance for interaction terms with treatment strategy allocation group regarding mortality
Age ≥75 years Hypertension
Age ≥75 years
Renal failure
Age ≥75 years CVI/Dm/COPD
Age ≥ 75 years CVI/Dm/COPD/PVD ≥2
HFpEF HFrEF
0.08* 0.05* 0.005† 0.05† 0.22 0.51 0.01* 0.11 0.19 0.61 0.03* 0.06 * 0.03* 0.52 0.61 0.01*
Significant interactions indicate different response to treatment with as compared to without presence of indicated criterion in bivariate interaction Cox-regression model.
* Less positive effect of (NT-pro)BNP-guided therapy in patients with this criterion.
† More positive effect of (NT-pro)BNP-guided therapy in patients with this criterion.
HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; CVI, cerebrovascular insult (also includes transient ischaemic attack); Dm, diabetes mellitus; COPD, chronic obstructive pulmonary disease; PVD, peripheral vascular disease.
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