Plasma brain natriuretic peptide-guided therapy to improve outcome in heart failure: the STARS-BNP Multicenter Study.
OBJECTIVE
The aim of this multicenter study was to evaluate the prognostic impact of a therapeutic strategy using plasma brain natriuretic peptide (BNP) levels.


BACKGROUND
The prognosis of chronic heart failure (CHF) remains poor, even among patients treated in specialized departments.


METHODS
A total of 220 New York Heart Association functional class II to III patients considered optimally treated with angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers, and diuretics by CHF specialists were randomized to medical treatment according to either current guidelines (clinical group) or a goal of decreasing BNP plasma levels <100 pg/ml (BNP group). Outpatient visits were scheduled every month for 3 months, then every 3 months. The primary combined end point was CHF-related death or hospital stay for CHF.


RESULTS
Both groups were similar for baseline clinical and biological characteristics. Left ventricular ejection fraction was slightly lower in the BNP group than in the clinical group (29.9 +/- 7.7% vs. 31.8 +/- 8.4%, p = 0.05). At the end of the first 3 months, all types of drugs were changed more frequently in the BNP group. Mean dosages of ACEIs and beta-blockers were significantly higher in the BNP group (p < 0.05), whereas the mean increase in furosemide dosage was similar in both groups. During follow-up (median 15 months), significantly fewer patients reached the combined end point in the BNP group (24% vs. 52%, p < 0.001).


CONCLUSIONS
In optimally treated CHF patients, a BNP-guided strategy reduced the risk of CHF-related death or hospital stay for CHF. The result was mainly obtained through an increase in ACEI and beta-blocker dosages.
Jourdain
Patrick
P
René Descartes University, Paris, France. patrick.jourdain@ch-pontoise.fr
Jondeau
Guillaume
G
Funck
François
F
Gueffet
Pascal
P
Le Helloco
Alain
A
Donal
Erwan
E
Aupetit
Jean F
JF
Aumont
Marie C
MC
Galinier
Michel
M
Eicher
Jean C
JC
Cohen-Solal
Alain
A
Juillière
Yves
Y
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002303:Cardiac Output, Low / Q000097:blood* / Q000188:drug therapy*; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D004232:Diuretics; D020097:Natriuretic Peptide, Brain