The use of brain natriuretic peptide levels to guide heart failure therapy did not reduce hospitalizations or improve quality of life in a study comparing that intensified approach against standard symptom-guided treatment.
In the Trial of Intensified vs. Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIMECHF), researchers found that contrary to their hypothesis, the new strategy was not helpful overall and was actually harmful in the subgroup of the oldest patients.
The findings indicate that despite the “undisputed diagnostic and prognostic importance” of brain natriuretic peptide (BNP) levels, they are no better than clinical symptom-based judgment for managing heart failure, said Dr. Matthias Pfisterer of University Hospital Basel (Switzerland) and his associates.
The investigators compared the two treatment approaches in 622 outpatients aged 60 and older who were followed for 18 months at 15 medical centers in Switzerland and Germany. Compared with symptom-guided treatment, intensified therapy guided by centrally obtained BNP levels did not improve survival free of hospitalization, the primary end point of the study. The rates of hospitalization-free survival were 41% and 40%, respectively.
Overall survival also did not differ significantly between patients who received BNP-guided therapy (84%) and those who received standard treatment (78%).
Patients aged 60–74 years showed some benefit with the intensified treatment approach, while those aged 75 and older did not (JAMA 2009;301:383–92).
BNP levels are no better than clinical symptom-based judgment for managing heart failure. DR. PFISTERER