Are Serial BNP Measurements Useful in Heart Failure Management?Response to Januzzi and Troughton
Serial Natriuretic Peptide Measurements Are Useful in Heart Failure Management
We have been asked to take the position that serial natriuretic peptide (NP) testing is useful for heart failure (HF) management. To do so, we primarily draw on our experience as physicians with active clinical practices replete with patients suffering from the diagnosis but also from our in-depth knowledge of NP testing and its strengths and weaknesses.
Response by Desai on p 508
To best consider the value of B-type natriuretic peptide (BNP) or its amino-terminal congener (N-terminal-proBNP [NT-proBNP]) for managing HF patients, it is worthwhile to first consider the need: Why would a biomarker be necessary beyond clinical means to assess and manage patients? Beyond this, we then identify the background science that led to the use of serial measurement of BNP or NT-proBNP, and then we finally review the aggregate data supporting their use in this capacity.
The HF Crisis: Why Do We Need to Consider Alternative Means to Manage Our Patients?
HF is reaching epidemic proportions, with millions of affected patients in the United States alone and more than half a million new cases yearly.1 With a lifetime risk for HF of >20% beyond middle age, the crisis is only expected to worsen as the population grows and ages.2 Furthermore, although prognosis in HF has improved over the past 50 years, it remains among the most lethal diagnoses in modern medicine, with a mortality rate that equals or exceeds many malignancies. Moreover, HF patients are frequently hospitalized, causing a financial burden on the healthcare system that will not abate soon.3 For all these reasons, a substantial focus now exists on improving the care of patients affected by HF.4
Landmark randomized, controlled trials (RCTs) have identified a wide range of pharmacological- and device-based therapies that improve HF symptoms, reduce the risk for HF progression, prevent HF hospitalization, and lower mortality rates related to the diagnosis. Unfortunately, however, contemporary studies …