Outpatient management of heart failure.
With the increasing prevalence of heart failure, the greater spectrum of proven therapies, the broader spectrum of cardiac dysfunction qualifying for treatment and the recognition that heart failure is difficult to diagnose, the need for an indicator of both the diagnosis and the efficacy of treatment in this condition is clear. Plasma concentrations of the B-type natriuretic peptides are related to cardiac function and cardiovascular prognosis. They parallel hemodynamic indicators of cardiac dysfunction and may therefore act as indicators of the adequacy of therapy. In the one published trial of outpatient treatment of heart failure guided by plasma BNP, 69 patients (LVEF < 40%, NYHA II-IV) were randomised to treatment according to plasma peptide levels or a clinical score. The primary end point of total cardiovascular events was reduced in BNP-guided patients (19 versus 54 events) with p < 0.001 in a multivariate analysis. The natriuretic peptides and particularly plasma BNP and aminoterminal proBNP promised to provide an objective guide for optimising treatment in heart failure.
Christchurch Cardioendocrine Research Group, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.
Mark
M
Richards
D000553:Ambulatory Care / Q000379:methods* / Q000639:trends; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005544:Forecasting; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000187:drug effects; D020098:Natriuretic Peptide, C-Type / Q000187:drug effects; D009520:New Zealand; D010045:Outpatients; D011379:Prognosis
D002316:Cardiotonic Agents; D020097:Natriuretic Peptide, Brain; D020098:Natriuretic Peptide, C-Type