Brain natriuretic peptide levels not superior to using symptom management
30 jan 2009- Using N-terminal brain natriuretic peptide (BNP) levels to guide heart failure therapy does not improve overall clinical outcomes or patient quality of life compared to using symptoms to guide treatment, according to a report published in the Jan. 28 issue of the Journal of the American Medical Association.
Matthias Pfisterer, M.D., of the University Hospital Basel in Switzerland, and colleagues conducted a randomized, controlled multicenter trial to compare 18-month outcomes of the two forms of guided heart failure therapies. A total of 499 patients (60 years or older) with systolic heart failure and an N-terminal BNP level of two times or more the upper limit of normal were randomized to receive treatment to either reduce symptoms or reduce BNP levels. Both types of interventions resulted in a similar rate of 18-month survival free of all-cause hospitalization (41 percent versus 40 percent for BNP-guided and symptom-guided therapy, respectively), the researchers report. Patient quality of life, which was improved over the 18-month study period, also was similar, the authors note. "While the BNP level may prove to be a useful tool for guiding therapy, it may be the method of reduction of BNP levels that matters most in improving outcomes for patients with heart failure," the authors of an accompanying editorial write. The study was partially funded by several pharmaceutical companies.
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