Natriuretic Peptide–Guided Heart Failure Therapy After the GUIDE-IT Study
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Testing for B-type natriuretic peptide (BNP) and its amino-terminal propeptide congener (NT-proBNP) has changed how patients with heart failure (HF) are evaluated, categorized, and managed worldwide. Recent HF clinical practice guidelines have bestowed a class I, Level of Evidence A, standing for BNP and NT-proBNP for diagnosis and prognosis in those affected by the diagnosis.1,2 Recent guideline updates also give recommendations for the use of BNP or NT-proBNP for assessing the risk for rehospitalization after hospital treatment for HF care, and identifying unaffected patients at risk for incident HF.2 However, whether natriuretic peptides can or should be used for guiding therapy in patients with chronic HF with reduced ejection fraction remains in limbo, considering positive meta-analyses alongside recent neutral results from the GUIDE-IT study (Guiding Evidence-Based Therapy Using Biomarker-Intensified Treatment in Heart Failure).3
Logic Behind Natriuretic Peptide–Guided HF Care
Why Consider a Biomarker to Guide HF Care?
Those opposed to the concept of biomarker-guided management point out that the care of patients with HF with reduced ejection fraction should be the same, regardless of biomarker results, and such treatment should comply with well-articulated clinical practice guidelines and consensus documents based on evidence from rigorous therapeutic clinical trials. Despite such goals, contemporary data suggest that glaring gaps in care quality exist for those affected by HF with reduced ejection fraction, who are very often not treated to guideline-directed medical therapy (GDMT) goals. Thus, a tool to optimize GDMT, in particular, allowing …