Abstract 3000: Upstep: A Randomized Study of BNP Guided Management of Systolic Heart Failure in Elderly Patients
Design: UPSTEP was a Scandinavian, randomized, parallel group multicenter study with a PROBE design (prospective, open, blinded evaluation) in heart failure (HF) patients in NYHA class II–IV, ejection fraction <40% and elevated BNP levels (BNP>150ng/L if<75 years, or >300ng/L if >75).
Aim: To study if BNP guided HF treatment improves outcome Methods: The patients were randomized to structured HF treatment according to guidelines with versus without BNP monitoring. The goal was to reduce BNP levels to <150ng/L and <300ng/L respectvely in the BNP guided arm as compared to baseline. The primary outcome variable was a composite endpoint of all-cause mortality/hospitalizations and worsening of HF.
Results; 280 patients from 24 hospitals were randomized. The treatment period mean time was 783 days. The groups (BNP vs. no BNP) were well balanced as regards to age (72 vs 71 years), gender (females: 28% vs 27%), BNP mean (808ng/L vs 899ng/L; p=0.34). There were no differences between the groups regarding the primary endpoint (p=0.25) or the individual components (all-cause mortality 32 vs 28 p=0.47; CV deaths 28 vs 24 p=0.43; HF related deaths 20 vs 18 p=0.65; all-cause hospitalizations 258 vs 274 p=0.33; CV hospitalizations 184 vs 200 p=0.25; or HF related hospitalizations 109 vs 118 p=0.40). There were no differences regarding elderly (>75 years) vs younger patients, responders (>30% decrease in BNP at the end of the study) vs non-responders, or days in hospital during the study period. Conclusion: This study confirms the results of previous studies that elderly patients do not seem to benefit from a BNP-guided treatment. Elderly patients might have other pathophysiological mechanisms compared with the younger patients.