(HealthDay News) — For high-risk patients with heart failure and reduced ejection fraction (HFrEF), an amino-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided treatment strategy does not improve clinical outcomes vs usual care, according to a study published in the Journal of the American Medical Association.
G. Michael Felker, MD, from the Duke Clinical Research Institute in Durham, NC, and colleagues randomized patients to an NT-proBNP-guided strategy, in which heart failure therapy was titrated with the goal of achieving a target NT-proBNP of less than 1000 pg/mL (446 patients), or usual care (448 patients who received heart failure care in accordance with published guidelines).
The study was stopped for futility when 894 of the planned 1100 patients had been enrolled with follow-up for a median of 15 months. The researchers found that the primary end point of composite of time-to-first heart failure hospitalization or cardiovascular mortality occurred in 37% of both the biomarker-guided and usual-care groups (adjusted hazard ratio, 0.98; 95% confidence interval, 0.79 to 1.22; P =.88). Cardiovascular mortality was 12% and 13% in the biomarker-guided and usual-care groups (hazard ratio, 0.94; 95% confidence interval, 0.65 to 1.37; P =.75). There was no significant difference between the groups in secondary end points or the decreases in NT-proBNP levels achieved.
“In high-risk patients with HFrEF, a strategy of NT-proBNP-guided therapy was not more effective than a usual care strategy in improving outcomes,” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
- Felker GM, Anstrom KJ, Adams KF, et al. Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in High-Risk Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial. JAMA. 2017 Aug 22. doi: 10.1001/jama.2017.10565