N‐terminal pro brain natriuretic peptide‐guided management in patients with heart failure and preserved ejection fraction: findings from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME‐CHF). (October 2013)

• Record Type: Journal Article
• Authors: Maeder, Micha T.; Rickenbacher, Peter; Rickli, Hans; Abbühl, Heidi; Gutmann, Marc; Erne, Paul; Vuilliomenet, André; Peter, Martin; Pfisterer, Matthias; Brunner‐La Rocca, Hans‐Peter
• Is Part Of: European journal of heart failure. Volume 15:Number 10(2013)
• Page Start: 1148
• Page End: 1156
• Publication Date: 2013-10
• Subjects: Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1093/eurjhf/hft076
• Languages: English
• ISSNs: 1388-9842

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ejhfhft076-sec-0001" sec-type="section"> <title>Aims</title> <p>To assess the effects of an NT‐proBNP‐guided medical management on 18‐month outcomes in patients with heart failure (HF) and preserved LVEF (HFpEF).</p> </sec> <sec id="ejhfhft076-sec-0002" sec-type="section"> <title>Methods and results</title> <p>Patients with HFpEF (LVEF >45%; <italic>n</italic> = 123) and HF with reduced LVEF (HFrEF; LVEF ≤45%; <italic>n</italic> = 499) with age ≥60 years, NYHA class ≥ II, and elevated NT‐proBNP (>400 ng/L or >800 ng/L depending on age) were randomized to medical therapy titrated only to reduce symptoms to NYHA ≤II (symptom‐guided) or also to reduce NT‐proBNP below the inclusion threshold (NT‐proBNP‐guided) during a 6‐month period. Patients were followed for an additional 12 months. Despite similar treatment escalation, NT‐proBNP reduction and symptom relief were less in HFpEF than in HFrEF. Hospitalization‐free survival at 18 months was worse in HFpEF than in HFrEF (<italic>P</italic> = 0.02), while survival and HF hospitalization‐free survival did not differ. Among HFpEF patients, NT‐proBNP reduction and symptom relief were similar in the symptom‐guided (<italic>n</italic> = 59) and NT‐proBNP‐guided (<italic>n</italic> = 64) group despite more aggressive treatment in the NT‐proBNP‐guided group. In contrast to effects in HFrEF, NT‐proBNP‐guided management tended to worsen 18‐month outcomes in HFpEF, with <italic>P</italic>‐values for the interactions between LVEF stratum and management strategy of 0.2 for hospitalization‐free survival, 0.03 for survival, and 0.01 for HF hospitalization‐free survival.</p> </sec> <sec id="ejhfhft076-sec-0003" sec-type="section"> <title>Conclusions</title> <p>Outcomes in HFpEF were not better than in HFrEF, and opposite effects of NT‐proBNP‐guided management were observed in HFpEF compared with HFrEF. These preliminary findings suggest that, in contrast to HFrEF, NT‐proBNP‐guided therapy may not be beneficial in HFpEF.</p> </sec> <sec id="ejhfhft076-sec-0004" sec-type="section"> <title>Trial registration</title> <p>ISRCTN43596477.</p> </sec> </abstract>