title: N-terminal pro-B-type natriuretic peptide-guided treatment for chronic heart failure: results from the BATTLESCARRED (NT-proBNP-Assisted Treatment To Lessen Serial Cardiac Readmissions and Death) trial.
abstract: OBJECTIVE
  The purpose of this study was to compare the effects of N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided therapy with those of intensive clinical management and with usual care (UC) on clinical outcomes in chronic symptomatic heart failure.
  
  
  BACKGROUND
  Initial trial results suggest titration of therapy guided by serial plasma B-type natriuretic peptide levels improves outcomes in patients with chronic heart failure, but the concept has not received widespread acceptance. Accordingly, we conducted a longer-term study comparing the effects of NT-proBNP-guided therapy with those of intensive clinical management and with UC of patients with heart failure.
  
  
  METHODS
  Three hundred sixty-four patients admitted to a single hospital with heart failure were randomly allocated 1:1:1 (stratified by age) to therapy guided by NT-proBNP levels or by intensive clinical management, or according to UC. Treatment strategies were applied for 2 years with follow-up to 3 years.
  
  
  RESULTS
  One-year mortality was less in both the hormone- (9.1%) and clinically-guided (9.1%) groups compared with UC (18.9%; p = 0.03). Three-year mortality was selectively reduced in patients <or=75 years of age receiving hormone-guided treatment (15.5%) compared with their peers receiving either clinically managed treatment (30.9%; p = 0.048) or UC (31.3%; p = 0.021).
  
  
  CONCLUSIONS
  Intensive management of chronic heart failure improves 1-year mortality compared with UC. Compared with clinically guided treatment and UC, hormone-guided treatment selectively improves longer-term mortality in patients <or=75 years of age. (NT-proBNP-Assisted Treatment To Lessen Serial Cardiac Readmissions and Death [BATTLESCARRED]; Australian New Zealand Clinical Trials Registry 12605000735651).
authors.affiliation: Department of Medicine, Christchurch Cardioendocrine Research Group, University of Otago, Christchurch, New Zealand.
authors.forename: John G
authors.initials: JG
authors.lastname: Lainchbury
authors.forename: Richard W
authors.initials: RW
authors.lastname: Troughton
authors.forename: Kim M
authors.initials: KM
authors.lastname: Strangman
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Frampton
authors.forename: Anna
authors.initials: A
authors.lastname: Pilbrow
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Yandle
authors.forename: Amjad K
authors.initials: AK
authors.lastname: Hamid
authors.forename: M Gary
authors.initials: MG
authors.lastname: Nicholls
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D004232:Diuretics / Q000008:administration & dosage*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009520:New Zealand / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D010446:Peptide Fragments / Q000097:blood*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain