Russian Heart Failure Journal 2015year Treatment of CHF patients based on monitoring of natriuretic peptide concentrations. Patient characteristics and study design

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Treatment of CHF patients based on monitoring of natriuretic peptide concentrations. Patient characteristics and study design

Koshkina D. E., Skvortsov A. A., Protasov V. N., Narusov O. Yu., Masenko V. P., Tereshchenko S. N.
Federal State Budgetary Institution, "Russian Cardiology Scientific and Production Center" of the RF Ministry of Health Care, 3rd Cherepkovskaya 15a, Moscow 121552

Keywords: NT-proBNP, treatment, CHF

DOI: 10.18087/rhfj.2015.1.2027

Background. Decreased concentration of NT-proBNP is associated with improved prognosis for patients with HF. However it is presently unclear whether intensive drug therapy for HF aimed at minimizing concentrations of natriuretic peptides (NUPs) has any advantage over a standard therapy. Aim. To evaluate expediency of a therapeutic tactics based on monitoring of NT-proBNP concentrations vs. a standard therapy in patients with high-risk CHF. Materials and methods. This single-center prospective study included 105 patients aged 18 to 75 with FC III–IV decompensated HF and LV EF <40 %. At discharge, high-risk patients were randomized to the standard treatment group and the group of treatment based on monitoring of NT-proBNP concentration at a ratio of 1:1. The study goal of NT-proBNP concentration was established at the level of <1000 pg / ml. The primary endpoint was a composite endpoint of cardiovascular mortality, decompensated HF, and rehospitalization for decompensated HF. Secondary endpoints were surrogate; efficacy and safety of the treatment were evaluated based on these endpoints. Results. This article presents the study design and detailed patient characteristics. The results will be published in detail in 2015. Conclusion. Results of this study may underlie development of a new approach to the treatment of high-risk HF patients who require intensified control and individualized tactics of the management to optimize the treatment and to improve the clinical condition, quality of life, and prognosis for these patients.
  1. Ambrosy AP, Fonarow GC, Butler J et al. The global health and economic burden of hospitalization for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol. 2014 Apr 1;63 (12):1123–33.
  2. Savarese G, Musella F, D’Amore C et al. Changes of natriuretic peptides predict hospital admission in patients with chronik heart failure. JACC Heart Fail. 2014 Apr;2 (2):148–58.
  3. Мареев В. Ю., Агеев Ф. Т., Арутюнов Г. П. и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Журнал Сердечная Недос­та­точность. 2013;14 (7): 379–472.
  4. Maggioni AP, Dahlstrom U, Filippatos G et al. EURObservational Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2010 Oct;12 (10):1076–84.
  5. Scott PA, Townsend PA, Ng LL et al. Defining potential to benefit from implantable cardioverter defibrillator therapy: the role of biomarkers. Europace. 2011 Oct;13 (10):1419–27.
  6. Berger R, Moertl D, Peter S et al. N-terminal pro-B-type natriuretic peptide-guided, intensive patient management in addition to multidisciplinary care in chronic heart failure a 3‑arm, prospective, randomized pilot study. J Am Coll Cardiol. 2010 Feb;55 (7):645–53.
  7. Jourdain P, Jondeau G, Funck F et al. Plasma brain natriuretic peptide-guided therapy to improve outcome in heart failure: the STARS-BNP Multicenter Study. J Am Coll Cardiol. 2007 Apr 24;49 (16):1733–9.
  8. Januzzi JL, Rehman SU, Mohammed AA et al. Use of amino-terminal pro-B-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction. J Am Coll Cardiol. 2011 Oct 25;58 (18):1881–9.
  9. Lainchbury JG, Troughton RW, Strangman KM et al. N-terminal pro-B-type natriuretic peptide-guided treatment for chronic heart failure: results from the BATTLESCARRED (NTproBNP- Assisted Treatment To Lessen Serial Cardiac Readmissions and Death) trial. J Am Coll Cardiol. 2009 Dec 29;55 (1):53–60.
  10. Pfisterer M, Buser P, Rickli H et al. BNP-guided vs symptom-gui­ded heart failure therapy: the Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) randomized trial. JAMA. 2009 Jan 28;301 (4):383–92.
  11. Eurlings LW, van Pol PE, Kok WE et al. Management of chronic heart failure guided by individual N-terminal pro-B-type natriuretic peptide targets: results of the PRIMA (Can PRo-brain-natriuretic peptide guided therapy of chronic heart failure IMprove heart fAilure morbidity and mortality?) study. J Am Coll Cardiol. 2010 Dec 14;56 (25):2090–100.
  12. Persson H, Erntell H, Eriksson B et al. Improved pharmacological therapy of chronic heart failure in primary care: a randomized Study of NT-proBNP Guided Management of Heart Failure- SIGNAL-HF (Swedish Intervention study-Guidelines and NT-proBNP AnaLysis in Heart Failure). Eur J Heart Fail. 2010 Dec;12 (12):1300–8.
  13. Shah MR, Califf RM, Nohria A et al. The STARBRITE trial: a rando­mi­zed, pilot study of B-type natriuretic peptide-guided therapy in patients with advanced heart failure. J Card Fail. 2011 Aug;17 (8):613–21.
  14. Karlstrom P, Alehagen U, Boman K et al. 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. Eur J Heart Fail. 2011 Oct;13 (10):1096–103.
  15. Felker GM, Ahmad T, Anstrom KJ et al. Rationale and Design of the GUIDE-IT Study: Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure. JACC Heart Fail. 2014 Oct;2 (5):457–65.
  16. Диагностика и лечение хронической и острой сердечной недостаточности. Клинические рекомендации. Доступны на / klinicheskie-rekomendatsii
  17. McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The task forse of diagnostics and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ECS. Eur Heart J. 2012 Jul;33 (14):1787–847.
  18. Yancy CW, Jessup M, Bozkurt B et al. 2013 ACCF / AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Oct 15;62 (16):e147–239.
  19. Masson S, Latini R, Anand IS et al. Direct comparison of B-type natriuretic peptide (BNP) and amino-terminal proBNP in a large population of patients with chronic and symptomatic heart failure: the Valsartan Heart Failure (Val-HeFT) data. Clin Chem. 2006 Aug;52 (8):1528–38.
  20. Masson S, Latini R, Anand IS et al. Prognostic value of changes in N-terminal pro-brain natriuretic peptide in Val-HeFT (Valsartan Heart Failure Trial). J Am Coll Cardiol. 2008 Sep 16;52 (12):997–1003.
  21. Januzzi Jr JL, Sakhuja R, O'Donoghue M et al. Utility of amino-terminal pro-brain natriuretic peptide testing for prediction of 1‑year mortality in patients with dyspnea treated in the emergency department. Arch Intern Med. 2006 Feb 13;166 (3):315–20.
  22. Rehman SU, Martinez-Rumayor A, Mueller T, Januzzi JL Jr. Independent and incremental prognostic value of multimarker testing in acute dyspnea: results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) study. Clin Chim Acta. 2008 Jun;392 (1-2):41–5.
  23. Logeart D, Thabut G, Jourdain P et al. Predischarge B-type natriuretic peptide assay for identifying patients at high risk of readmission after decompensated heart failure. J Am Coll Cardiol. 2004 Feb 18;43 (4):635–41.
  24. Schou M, Gustafsson F, Nielsen PH et al. Unexplained week-to-week variation in BNP and NT-proBNP is low in chronic heart failure patients during steady state. Eur J Heart Fail. 2007 Jan;9 (1):68–74.
  25. Small RS, Whellan DJ, Boyle A et al. Implantable device diagnostics on day of discharge identify heart failure patients at increased risk for early readmission for heart failure. Eur J Heart Fail. 2014 Apr;16 (4):419–25.
  26. Corrao G, Ghirardi A, Ibrahim B et al. Burden of new hospitalization for heart failure: a population-based investigation from Italy. Eur J Heart Fail. 2014 Jul;16 (7):729–36.
  27. Bottle A, Aylin P, Bell D. Effect of the readmission primary diagnosis and time interval in heart failure patients: analysis of English administrative data. Eur J Heart Fail. 2014 Aug;16 (8):846–53.
  28. Schou M, Gustafsson F, Videbaek L et al. Design and methodology of the NorthStar Study: NT-proBNP stratified follow-up in outpatient heart failure clinics – a randomized Danish multicenter study. Am Heart J. 2008 Oct;156 (4):649–55.
Koshkina D. E., Skvortsov A. A., Protasov V. N. et al. Treatment of CHF patients based on monitoring of natriuretic peptide concentrations. Patient characteristics and study design. Russian Heart Failure Journal. 2015;16 (1):3–10

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