Abstract 5946: Ntprobnp Guided Treatment for Chronic Heart Failure: Results from the Battlescarred Trial
Three hundred and sixty four (364) patients satisfying Framingham and ESC criteria for symptomatic heart failure were randomized 1:1:1 (with prospective sub-stratification according to age ≤ or > 75 years) to Usual Care (UC), Intensive Clinical Management (CC) or Hormone Guided Care (HGC) incorporating serial measurement of NTproBNP levels into the treatment algorithm. The 3 treatment strategies were applied for 2 years. Minimum follow-up was 12 months with median follow-up 2.8 years. The primary end-points were all-cause mortality and death+/− admission with decompensated Heart Failure (HF). Groups were matched for age (median 76–77years); LVEF (37%) and baseline NTproBNP (medians 235–239 pmol/L ie 1997–2021 pg/ml). All-cause mortality at 12 months was halved by both intensive strategies (18.9, 9.1 and 9.1% respectively for UC, CC and HGC respectively; (P=0.028 overall and P=0.029 for pairwise (UC vs CC and UC vs HGC) intergroup comparisons). At 2 and 3 years follow-up mortality rates did not differ overall but significant treatment effects were observed in those aged ≤75years (P<0.025 for interaction between age and management strategy at all time points). At 1, 2 and 3 years, in those ≤ 75 years, cumulative all-cause mortality was 1.7, 7.3 and 15.5% in HGC; 7.3, 20.0, and 30.9% in CC and 20.3, 23.4 and 31.3% in UC. HGC significantly reduced cumulative mortality below that in UC throughout follow-up (P=0.001 and P=0.021 at 1 and 3 years respectively) and also below that in CC by 3 years follow-up (P=0.048) whereas CC conferred no advantage over UC after one year of follow-up (P=0.04 and ns at 1 and 3 years respectively). The composite end-point of death+/− admission with HF was reduced only in younger patients receiving HGC (P<0.05 at 1, 2 and 3 years follow-up compared with UC). Total days “alive and not in hospital with HF” over 3 years of follow-up, averaged 206 days more in this subgroup than in their peers within the UC group (P<0.05). No benefits were observed in those aged > 75 years. Intensive management of chronic HF reduces one-year mortality compared to usual care. Over long-term follow-up hormone guided therapy may offer an additional mortality advantage over otherwise similarly intensive specialist clinic-based care particularly in those aged ≤ 75 years.