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
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 gr...
Published in: | European Journal of Heart Failure |
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Linköpings universitet, Kardiologi
2011
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Online Access: | http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-71379 https://doi.org/10.1093/eurjhf/hfr078 |
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ftlinkoepinguniv:oai:DiVA.org:liu-71379 2023-05-15T17:45:05+02:00 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 Karlstrom, Patric Alehagen, Urban Boman, Kurt Dahlström, Ulf 2011 application/pdf http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-71379 https://doi.org/10.1093/eurjhf/hfr078 eng eng Linköpings universitet, Kardiologi Linköpings universitet, Hälsouniversitetet Östergötlands Läns Landsting, Kardiologiska kliniken US Division of Cardiology, Department of Medicine, County Hospital Ryhov, Jönköping, Sweden Institution of Public Health and Clinical Medicine, Umeå University, Sweden European Journal of Heart Failure, 1388-9842, 2011, 13:10, s. 1096-1103 http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-71379 doi:10.1093/eurjhf/hfr078 ISI:000295169600009 info:eu-repo/semantics/openAccess PROBE design Systolic heart failure Natriuretic peptides BNP-guided treatment Medical and Health Sciences Medicin och hälsovetenskap Article in journal info:eu-repo/semantics/article text 2011 ftlinkoepinguniv https://doi.org/10.1093/eurjhf/hfr078 2022-05-01T08:18:41Z 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|| Article in Journal/Newspaper Northern Sweden LIU - Linköping University: Publications (DiVA) European Journal of Heart Failure 13 10 1096 1103 |
institution |
Open Polar |
collection |
LIU - Linköping University: Publications (DiVA) |
op_collection_id |
ftlinkoepinguniv |
language |
English |
topic |
PROBE design Systolic heart failure Natriuretic peptides BNP-guided treatment Medical and Health Sciences Medicin och hälsovetenskap |
spellingShingle |
PROBE design Systolic heart failure Natriuretic peptides BNP-guided treatment Medical and Health Sciences Medicin och hälsovetenskap Karlstrom, Patric Alehagen, Urban Boman, Kurt Dahlström, Ulf 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 |
topic_facet |
PROBE design Systolic heart failure Natriuretic peptides BNP-guided treatment Medical and Health Sciences Medicin och hälsovetenskap |
description |
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|| |
format |
Article in Journal/Newspaper |
author |
Karlstrom, Patric Alehagen, Urban Boman, Kurt Dahlström, Ulf |
author_facet |
Karlstrom, Patric Alehagen, Urban Boman, Kurt Dahlström, Ulf |
author_sort |
Karlstrom, Patric |
title |
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 |
title_short |
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 |
title_full |
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 |
title_fullStr |
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 |
title_full_unstemmed |
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 |
title_sort |
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 |
publisher |
Linköpings universitet, Kardiologi |
publishDate |
2011 |
url |
http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-71379 https://doi.org/10.1093/eurjhf/hfr078 |
genre |
Northern Sweden |
genre_facet |
Northern Sweden |
op_relation |
European Journal of Heart Failure, 1388-9842, 2011, 13:10, s. 1096-1103 http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-71379 doi:10.1093/eurjhf/hfr078 ISI:000295169600009 |
op_rights |
info:eu-repo/semantics/openAccess |
op_doi |
https://doi.org/10.1093/eurjhf/hfr078 |
container_title |
European Journal of Heart Failure |
container_volume |
13 |
container_issue |
10 |
container_start_page |
1096 |
op_container_end_page |
1103 |
_version_ |
1766147821884407808 |