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The STARBRITE trial: a randomized, pilot study of B-type natriuretic peptide-guided therapy in patients with advanced heart failure.

Publication ,  Journal Article
Shah, MR; Califf, RM; Nohria, A; Bhapkar, M; Bowers, M; Mancini, DM; Fiuzat, M; Stevenson, LW; O'Connor, CM
Published in: J Card Fail
August 2011

BACKGROUND: STARBRITE, a multicenter randomized pilot trial, tested whether outpatient diuretic management guided by B-type natriuretic peptide (BNP) and clinical assessment resulted in more days alive and not hospitalized over 90 days compared with clinical assessment alone. METHODS AND RESULTS: A total of 130 patients from 3 sites with left ventricular ejection fraction ≤35% were enrolled during hospitalization for heart failure (HF) and randomly assigned to therapy guided by BNP and clinical assessment (BNP strategy) or clinical assessment alone. The clinical goal was resolution of congestion without hypotension or renal dysfunction. In the BNP arm, therapy was adjusted to achieve optimal fluid status, defined as the BNP level and congestion score obtained at the time of discharge. In the clinical assessment arm, therapy was titrated to achieve optimal fluid status, represented by the patient's signs and symptoms at the time of discharge. Exclusion criteria were serum creatinine >3.5 mg/dL and acute coronary syndrome. Follow-up was done in HF clinics. BNP was measured with the use of a rapid assay test. There was no significant difference in number of days alive and not hospitalized (hazard ratio 0.72, 95% confidence interval 0.41-1.27; P = .25), change in serum creatinine, or change in systolic blood pressure (SBP). BNP strategy was associated with a trend toward a lower blood urea nitrogen (24 mg/dL vs 29 mg/dL; P = .07); BNP strategy patients received significantly more angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and the combination of ACE inhibitor or angiotensin receptor blocker plus beta-blockers. CONCLUSIONS: BNP strategy was not associated with more days alive and not hospitalized, but the strategy appeared to be safe and was associated with increased use of evidence-based medications.

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Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

August 2011

Volume

17

Issue

8

Start / End Page

613 / 621

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Pilot Projects
  • Natriuretic Peptide, Brain
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Follow-Up Studies
  • Female
 

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Shah, M. R., Califf, R. M., Nohria, A., Bhapkar, M., Bowers, M., Mancini, D. M., … O’Connor, C. M. (2011). The STARBRITE trial: a randomized, pilot study of B-type natriuretic peptide-guided therapy in patients with advanced heart failure. J Card Fail, 17(8), 613–621. https://doi.org/10.1016/j.cardfail.2011.04.012
Shah, Monica R., Robert M. Califf, Anju Nohria, Manju Bhapkar, Margaret Bowers, Donna M. Mancini, Mona Fiuzat, Lynne W. Stevenson, and Christopher M. O’Connor. “The STARBRITE trial: a randomized, pilot study of B-type natriuretic peptide-guided therapy in patients with advanced heart failure.J Card Fail 17, no. 8 (August 2011): 613–21. https://doi.org/10.1016/j.cardfail.2011.04.012.
Shah MR, Califf RM, Nohria A, Bhapkar M, Bowers M, Mancini DM, 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.
Shah, Monica R., 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, vol. 17, no. 8, Aug. 2011, pp. 613–21. Pubmed, doi:10.1016/j.cardfail.2011.04.012.
Shah MR, Califf RM, Nohria A, Bhapkar M, Bowers M, Mancini DM, Fiuzat M, Stevenson LW, O’Connor CM. 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):613–621.
Journal cover image

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

August 2011

Volume

17

Issue

8

Start / End Page

613 / 621

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Pilot Projects
  • Natriuretic Peptide, Brain
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Follow-Up Studies
  • Female