BNP-guided therapy helps heart failure outcomes, no effect in hospitalizations
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Therapy guided by B-type natriuretic peptide (BNP) reduces all-cause mortality in patients with chronic heart failure compared with usual clinical care, especially in patients younger than 75 years, even if it doesn't reduce hospitalizations or increase hospital-free survival.
To examine the overall effect of BNP-guided drug therapy on outcomes in patients with chronic heart failure, researchers did a meta-analysis of eight prospective randomized, controlled trials of 1,726 outpatients with a history of heart failure. Eligible trials (mean duration, 16 months; range, 3 to 24 months) enrolled more than 20 patients and compared BNP-guided drug therapy versus usual clinical care in an outpatient setting. Results were reported in the March 22 Archives of Internal Medicine.
There was a significantly lower risk of all-cause mortality (relative risk [RR], 0.76; 95% CI, 0.63 to 0.91; P=0.003) in the BNP-guided therapy group compared with the control group. Patients younger than 75 years in the BNP-guided group had significantly lower all-cause mortality (RR, 0.52; 95% CI, 0.33 to 0.82; P=0.005). However, patients 75 years or older had no reduction in mortality with BNP-guided therapy (RR, 0.94; 95% CI, 0.71 to 1.25; P=0.70).
Risk of all-cause hospitalization and survival free of any hospitalization was not significantly different between groups (RR, 0.82; 95% CI, 0.64 to 1.05; P=0.12 and RR, 1.07; 95% CI, 0.85 to 1.34; P=0.58, respectively). More patients in the BNP groups had their doses of angiotensin-converting enzyme inhibitors and β-blockers titrated up to reach target levels (21% and 22% in the BNP group vs. 11.7% and 12.5% in the control group, respectively).
The authors noted that while BNP-guided therapy can decrease all-cause mortality, a major study limitation was that they were not able to examine key clinical end points, such as hospitalization for heart failure, where BNP-guided therapy should theoretically improve outcomes.