Abstract 10186: Treatment of Patients Recently Admitted for Acute Heart Failure Based on NT-proBNP Plasma Levels Measurements. Results of a Prospective, Randomized, Single-centre Trial.
Acute heart failure (AHF) is associated with poor prognosis. High plasma levels of N-terminal B-type natriuretic peptide (NT-proBNP) at discharge identify patients at higher risk. We hypothesized that therapy changes based on knowledge of NT-proBNP levels may improve prognosis. 325 consecutive patients admitted for AHF were prospectively randomized to NT-proBNP guided therapy (intervention group) or standard care (control). Blood samples were drawn 48–72 hours before planned discharge and at discharge. They were unknown in the control group but known to the physician in the intervention group who intensified medical treatment when NT-proBNP was >3000 pg/mL. Increase in diuretic doses, initiation and/or uptitration of ACEi/ARBs, aldosterone antagonists and beta-blockers, and i.v. administration of inotropic agents were used in 62, 15, 9, 14, 12 of the 70 patients of the intervention group. NT-proBNP decreased from 2443, 1201–4417 (median, IQR) at pre-discharge, to 2111, 1804–4647 pg/mL at discharge in the control group and from 2406, 1306–4994, to 2110, 1233–4178 pg/mL in the intervention group (p=0.0027 for comparison of changes between the two groups). Larger differences were found in the patients with pre-discharge NT-proBNP levels >3000 pg/mL: from 5546, 3709–7954 to 5494, 3627–7600 in the control group and from 5810, 4296–11127 to 4722, 3146–7854 in the intervention group (p=0.0022). Predischarge variables including NT-proBNP levels did not differ between the intervention and the control group. During 539±337 days of follow-up, 72 patients died (22%;) and 192 (59%;) were hospitalized for AHF. Death and AHF hospitalization rates (combined pre-specified primary end-point) as well as AHF hospitalizations alone were similar in the intervention and control group (HR, 0.98; 95%; CI, 0.74–1.28 and 1.04, 0.78–1.38, respectively) whereas all-cause mortality was reduced in the intervention group (HR, 0.54; 95%; CI, 0.33–0.88). Thus, NT-proBNP guided therapy changes did not lead to differences in the primary endpoint death/hospitalization rate compared to standard care in AHF patients. Although not powered for survival, our study suggests that NT-proBNP guided therapy might reduce mortality in AHF patients.
- © 2010 by American Heart Association, Inc.