Using Heart Biomarker Level to Guide Therapy Not Helpful for Heart Failure Patients

Using a measure of the hormone N-terminal brain natriuretic peptide (BNP) to guide therapy for older patients with heart failure did not improve overall clinical or quality of life outcomes compared to patients receiving conventional symptom-guided therapy, according to a study in the January 28 issue of JAMA.

BNP is produced predominantly by the heart muscle cells, and levels of BNP are increased in patients with congestive heart failure. Therapy for heart failure guided by N-terminal BNP has been proposed to improve outcomes compared with conventional therapy in patients with chronic heart failure in some studies. However, these studies were small, not conclusive, had limited follow-up and focused on younger patients, according to background information in the article. Intensified N-terminal BNP–guided therapy may be particularly beneficial for older patients who are less physically active and in whom symptoms are less reliable. Heart failure is the most common reason for hospitalization in patients age 65 years or older.

Matthias Pfisterer, M.D., of University Hospital Basel, Switzerland, and colleagues compared a N-terminal BNP–guided strategy to the standard symptom-guided therapy for 499 patients age 60 years or older with chronic heart failure, who had prior hospitalization for heart failure within 1 year and N-terminal BNP level of 2 or more times the upper limit of normal. The study (Trial of Intensified vs. Standard Medical Therapy in Elderly Patients With Congestive Heart Failure [TIME-CHF]) had an 18-month follow-up. Patients were randomized to receive treatment to reduce symptoms of a certain level of heart failure (symptom-guided therapy) or treatment to reach BNP level of 2 times or less the upper limit of normal and reduce symptoms of a certain level of heart failure (BNP–guided therapy).