Brain natriuretic peptide-guided treatment does not improve morbidity and mortality in extensively treated patients with chronic heart failure: responders to treatment have a significantly better outcome

• Published in: European Journal of Heart Failure
• Main Authors: Karlstrom, Patric, Alehagen, Urban, Boman, Kurt, Dahlström, Ulf
• Format: Article in Journal/Newspaper
• Language: English
• Published: Linköpings universitet, Kardiologi 2011
• Subjects: PROBE design; Systolic heart failure; Natriuretic peptides; BNP-guided treatment; Medical and Health Sciences; Medicin och hälsovetenskap; Northern Sweden
• Online Access: http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-71379; https://doi.org/10.1093/eurjhf/hfr078

Aim To determine whether brain natriuretic peptide (BNP)-guided heart failure (HF) treatment improves morbidity and/or mortality when compared with conventional treatment. less thanbrgreater than less thanbrgreater thanMethods and results UPSTEP was an investigator-initiated, randomized, parallel group, multicentre study with a PROBE design. Symptomatic patients with worsening HF, New York Heart Association class II-IV, ejection fraction andlt;40% and elevated BNP levels, were included. All patients (n = 279) were treated according to recommended guidelines and randomized to BNP-guided (BNP) or to conventional (CTR) HF treatment. The goal was to reduce BNP levels to andlt;150 ng/L in younger patients and andlt;300 ng/L in elderly patients, respectively. The primary outcome was a composite of death due to any cause, need for hospitalization and worsening HF. The study groups were well matched, including for BNP concentration at entry (mean: 808 vs. 899 ng/L; P = 0.34). There were no significant differences between the groups regarding either the primary outcome (P = 0.18) or any of the secondary endpoints. There were no differences for the pre-specified analyses; days out of hospital, and younger vs. elderly. A subgroup analysis comparing treatment responders (andgt;30% decrease in baseline BNP value) vs. non-responders found improved survival among responders (P andlt; 0.0001 for the primary outcome), and all of the secondary endpoints were also improved. less thanbrgreater than less thanbrgreater thanConclusions Morbidity and mortality were not improved by HF treatment guided by BNP levels. However, BNP responders had a significantly better clinical outcome than non-responders. Future research is needed to elucidate the responsible pathophysiological mechanisms in this sub-population. Funding Agencies|Swedish Heart-Lung Foundation||Regional Research Foundation in South-eastern Sweden||Regional Research Foundation in Northern Sweden||Biosite International||Infiniti Medical AB||