番茄社区

ORLANDO -- For patients who were stabilized after acute decompensated heart failure, aggressive management to achieve a 30% reduction in N-terminal pro b-type natriuretic peptide (NT-proBNP) levels did not yield better clinical outcomes, the PRIMA II study found.

Patients undergoing NT-proBNP-guided therapy goal of had no advantage in mortality and heart failure readmissions at 180 days (36% versus 38% for conventional strategy, HR 0.99, 95% CI 0.72-1.36). Also similar between groups were:

• Median number of days alive and outside of the hospital (178 versus 180, P=0.39)
• Heart failure readmissions (27% versus 29%, P=0.68)
• All-cause mortality (19% versus 17%, P=0.63)

But while an intensified approach did not improve most outcomes, actually reaching the 30% target reduction in NT-proBNP was strongly tied to improved rehospitalization-free survival (HR 0.39 for readmission or death, 95% CI 0.27-0.55), according to the late-breaking presentation by , of Academic Medical Center in Amsterdam, at the .

At the end of 180 days, heart failure rehospitalization and death were most likely for patients who did not reach the 30% goal despite aggressive management (59% chance), followed by those receiving NT-proBNP-guided therapy to achieve the target reduction (49%). Patients who met the NT-proBNP target without aggressive therapy had the lowest mortality/rehospitalization rate at 28%.

PRIMA II was an international randomized controlled trial of 405 patients who had new-onset and acute-on-chronic acute decompensated heart failure and NT-proBNP levels greater than 1,700 ng/L on hospital admission.

Around 60% of patients had already reached the 30% NT-proBNP reduction goal after clinical stabilization. Only the group who did not reduce by 30% at that point was enrolled into the current trial.

"What was surprising ... in this study was that by day 3, more than 60% of patients had already reduced by 30%, suggesting that an early reduction in NT-proBNP is possible, regardless of whether intended or not," said , of Massachusetts General Hospital in Boston.

So few patients were actually randomized to NT-proBNP guidance versus clinical management, he told 番茄社区, that the investigators weren't able to demonstrate an improvement in outcomes in 6 months in the guided therapy arm.

Even so, "if a 30% reduction was seen regardless of randomization, these patients did fantastically," he continued.

"This really emphasizes that this 30% reduction is valid regardless [of whether] it's achieved by guidance or achieved spontaneously."

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