Natriuretic Peptide Response and Outcomes in Chronic Heart Failure With Reduced Ejection Fraction.
Publication/Presentation Date
9-3-2019
Abstract
BACKGROUND: The GUIDE-IT (GUIDing Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) trial demonstrated that a strategy to "guide" application of guideline-directed medical therapy (GDMT) by reducing amino-terminal pro-B-type natriuretic peptide (NT-proBNP) was not superior to GDMT alone.
OBJECTIVES: The purpose of this study was to examine the prognostic meaning of NT-proBNP changes following heart failure (HF) therapy intensification relative to the goal NT-proBNP value of 1,000 pg/ml explored in the GUIDE-IT trial.
METHODS: A total of 638 study participants were included who were alive and had available NT-proBNP results 90 days after randomization. Rates of subsequent cardiovascular (CV) death/HF hospitalization or all-cause mortality during follow-up and Kansas City Cardiomyopathy Questionnaire (KCCQ) overall scores were analyzed.
RESULTS: A total of 198 (31.0%) subjects had an NT-proBNP ≤1,000 pg/ml at 90 days with no difference in achievement of NT-proBNP goal between the biomarker-guided and usual care arms. NT-proBNP ≤1,000 pg/ml by 90 days was associated with longer freedom from CV/HF hospitalization or all-cause mortality (p < 0.001 for both) and lower adjusted hazard of subsequent HF hospitalization/CV death (hazard ratio: 0.26; 95% confidence interval: 0.15 to 0.46; p < 0.001) and all-cause mortality (hazard ratio: 0.34; 95% confidence interval: 0.15 to 0.77; p = 0.009). Regardless of elevated baseline concentration, an NT-proBNP ≤1,000 pg/ml at 90 days was associated with better outcomes and significantly better KCCQ overall scores (p = 0.02).
CONCLUSIONS: Patients with heart failure with reduced ejection fraction whose NT-proBNP levels decreased to ≤1,000 pg/ml during GDMT had better outcomes. These findings may help to understand the results of the GUIDE-IT trial. (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment [GUIDE-IT]; NCT01685840).
Volume
74
Issue
9
First Page
1205
Last Page
1217
ISSN
1558-3597
Published In/Presented At
Januzzi, J. L., Jr, Ahmad, T., Mulder, H., Coles, A., Anstrom, K. J., Adams, K. F., Ezekowitz, J. A., Fiuzat, M., Houston-Miller, N., Mark, D. B., Piña, I. L., Passmore, G., Whellan, D. J., Cooper, L. S., Leifer, E. S., Desvigne-Nickens, P., Felker, G. M., & O'Connor, C. M. (2019). Natriuretic Peptide Response and Outcomes in Chronic Heart Failure With Reduced Ejection Fraction. Journal of the American College of Cardiology, 74(9), 1205–1217. https://doi.org/10.1016/j.jacc.2019.06.055
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
31466618
Department(s)
Administration and Leadership
Document Type
Article