Can NT-proBNP-guided therapy during hospital admission for acute heart failure reduce mortality and readmissions? Interview with:
Susan Stienen, MD

Department of Cardiology
Academic Medical Center University of Amsterdam
Amsterdam, the Netherland What is the background for this study?

Response: Prognosis of patients admitted for and discharged after acute decompensated heart failure (ADHF) is poor, with a readmission and mortality rate of up to 50% of patients at 6 months. Previous studies demonstrated that a ≤30% NT-proBNP reduction from admission to discharge for ADHF is a strong predictor of HF readmissions and mortality, while those patients with a > 30% reduction in NT-proBNP had a far better prognosis. We conducted a randomized clinical trial in ADHF patients to study the effect of NT-proBNP-guided treatment with a target of NT-proBNP reduction of >30% from admission to discharge, versus conventional treatment. The guided arm used a therapy algorithm that included HF medication, review of rhythm problems and possible ischemia, and had a reminder of a possible indication for CRT-D.

A total of 405 patients were randomized after an initial period of clinical stabilization, to receive NT-proBNP-guided or conventional therapy. Intention-to-treat analyses were performed in 404 patients. What are the main findings?

Response: Main findings are:
1) Although significantly more patients in the NT-proBNP-guided therapy attained the NT-proBNP target of >30% reduction at discharge compared to patients in the conventional therapy group (82% vs. 64%, p=0.001),
2) There was no significant difference in:
a. HF readmission / death rate within 180 days after randomization
b. Number of days alive and outside of the hospital within 180 days after discharge. What should readers take away from your report?

Response: Overall, NT-proBNP-guided therapy targeting those patients who do not attain a NT-proBNP reduction of > 30% before discharge is not beneficial over conventional therapy in acute decompensated heart failure patients. However, an NT-proBNP reduction of >30% at clinical stabilization was independently associated with a better prognosis. What recommendations do you have for future research as a result of this study?

Response: It might be interesting to see whether a combination of NT-proBNP targets of both a relative and absolute target improves outcome, since combining these targets would have an impact on more patients that we ultimately had to guide in our trial. This also pertains to the question whether you should target only those patients at high risk, or also those at moderate risk.

It would also be interesting to see whether it is possible to predict at an early stage which patients will not attain a > 30% reduction, so that more time and effort is allowed for guiding these patients through the first few days of hospitalization. Is there anything else you would like to add?

Response: We did not know at forehand that it was not possible to attain our relatively easy NT-proBNP target in all patients at discharge, and it does not seem to be a result of a lesser adherence to the guidelines. These are new findings. Thank you for your contribution to the community.

Citation: Late-breaking Abstract September 18 2016, presented during the Heart Failure Society of America’s 20th Annual Scientific Meeting in Orlando, Florida.

PRIMA II: Can NT-proBNP-guided therapy during hospital admission for acute decompensated heart failure reduce mortality and readmissions? An international, multicenter, randomized clinical trial

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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