Skip to main content
Journal cover image

Which heart failure patients profit from natriuretic peptide guided therapy? A meta-analysis from individual patient data of randomized trials.

Publication ,  Journal Article
Brunner-La Rocca, H-P; Eurlings, L; Richards, AM; Januzzi, JL; Pfisterer, ME; Dahlström, U; Pinto, YM; Karlström, P; Erntell, H; Berger, R ...
Published in: Eur J Heart Fail
December 2015

AIMS: Previous analyses suggest that heart failure (HF) therapy guided by (N-terminal pro-)brain natriuretic peptide (NT-proBNP) might be dependent on left ventricular ejection fraction, age and co-morbidities, but the reasons remain unclear. METHODS AND RESULTS: To determine interactions between (NT-pro)BNP-guided therapy and HF with reduced [ejection fraction (EF) ≤45%; HF with reduced EF (HFrEF), n = 1731] vs. preserved EF [EF > 45%; HF with preserved EF (HFpEF), n = 301] and co-morbidities (hypertension, renal failure, chronic obstructive pulmonary disease, diabetes, cerebrovascular insult, peripheral vascular disease) on outcome, individual patient data (n = 2137) from eight NT-proBNP guidance trials were analysed using Cox-regression with multiplicative interaction terms. Endpoints were mortality and admission because of HF. Whereas in HFrEF patients (NT-pro)BNP-guided compared with symptom-guided therapy resulted in lower mortality [hazard ratio (HR) = 0.78, 95% confidence interval (CI) 0.62-0.97, P = 0.03] and fewer HF admissions (HR = 0.80, 95% CI 0.67-0.97, P = 0.02), no such effect was seen in HFpEF (mortality: HR = 1.22, 95% CI 0.76-1.96, P = 0.41; HF admissions HR = 1.01, 95% CI 0.67-1.53, P = 0.97; interactions P < 0.02). Age (74 ± 11 years) interacted with treatment strategy allocation independently of EF regarding mortality (P = 0.02), but not HF admission (P = 0.54). The interaction of age and mortality was explained by the interaction of treatment strategy allocation with co-morbidities. In HFpEF, renal failure provided strongest interaction (P < 0.01; increased risk of (NT-pro)BNP-guided therapy if renal failure present), whereas in HFrEF patients, the presence of at least two of the following co-morbidities provided strongest interaction (P < 0.01; (NT-pro)BNP-guided therapy beneficial only if none or one of chronic obstructive pulmonary disease, diabetes, cardiovascular insult, or peripheral vascular disease present). (NT-pro)BNP-guided therapy was harmful in HFpEF patients without hypertension (P = 0.02). CONCLUSION: The benefits of therapy guided by (NT-pro)BNP were present in HFrEF only. Co-morbidities seem to influence the response to (NT-pro)BNP-guided therapy and may explain the lower efficacy of this approach in elderly patients.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

December 2015

Volume

17

Issue

12

Start / End Page

1252 / 1261

Location

England

Related Subject Headings

  • Stroke Volume
  • Randomized Controlled Trials as Topic
  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Male
  • Humans
  • Heart Failure
  • Female
  • Cardiovascular System & Hematology
  • Aged
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Brunner-La Rocca, H.-P., Eurlings, L., Richards, A. M., Januzzi, J. L., Pfisterer, M. E., Dahlström, U., … Troughton, R. W. (2015). Which heart failure patients profit from natriuretic peptide guided therapy? A meta-analysis from individual patient data of randomized trials. Eur J Heart Fail, 17(12), 1252–1261. https://doi.org/10.1002/ejhf.401
Brunner-La Rocca, Hans-Peter, Luc Eurlings, A Mark Richards, James L. Januzzi, Matthias E. Pfisterer, Ulf Dahlström, Yigal M. Pinto, et al. “Which heart failure patients profit from natriuretic peptide guided therapy? A meta-analysis from individual patient data of randomized trials.Eur J Heart Fail 17, no. 12 (December 2015): 1252–61. https://doi.org/10.1002/ejhf.401.
Brunner-La Rocca H-P, Eurlings L, Richards AM, Januzzi JL, Pfisterer ME, Dahlström U, et al. Which heart failure patients profit from natriuretic peptide guided therapy? A meta-analysis from individual patient data of randomized trials. Eur J Heart Fail. 2015 Dec;17(12):1252–61.
Brunner-La Rocca, Hans-Peter, et al. “Which heart failure patients profit from natriuretic peptide guided therapy? A meta-analysis from individual patient data of randomized trials.Eur J Heart Fail, vol. 17, no. 12, Dec. 2015, pp. 1252–61. Pubmed, doi:10.1002/ejhf.401.
Brunner-La Rocca H-P, Eurlings L, Richards AM, Januzzi JL, Pfisterer ME, Dahlström U, Pinto YM, Karlström P, Erntell H, Berger R, Persson H, O’Connor CM, Moertl D, Gaggin HK, Frampton CM, Nicholls MG, Troughton RW. Which heart failure patients profit from natriuretic peptide guided therapy? A meta-analysis from individual patient data of randomized trials. Eur J Heart Fail. 2015 Dec;17(12):1252–1261.
Journal cover image

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

December 2015

Volume

17

Issue

12

Start / End Page

1252 / 1261

Location

England

Related Subject Headings

  • Stroke Volume
  • Randomized Controlled Trials as Topic
  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Male
  • Humans
  • Heart Failure
  • Female
  • Cardiovascular System & Hematology
  • Aged