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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)
Author(s) -
Maeder Micha T.,
Rickenbacher Peter,
Rickli Hans,
Abbühl Heidi,
Gutmann Marc,
Erne Paul,
Vuilliomenet André,
Peter Martin,
Pfisterer Matthias,
BrunnerLa Rocca HansPeter
Publication year - 2013
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hft076
Subject(s) - medicine , heart failure , ejection fraction , cardiology , natriuretic peptide , heart failure with preserved ejection fraction , randomized controlled trial , n terminal pro brain natriuretic peptide , medical therapy
Aims 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). Methods and results Patients with HFpEF (LVEF >45%; n = 123) and HF with reduced LVEF (HFrEF; LVEF ≤45%; n = 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 ( P = 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 ( n = 59) and NT‐proBNP‐guided ( n = 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 P ‐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. Conclusions 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. Trial registration ISRCTN43596477.