N-terminal pro-B-type natriuretic peptide-guided, intensive patient management in addition to multidisciplinary care in chronic heart failure a 3-arm, prospective, randomized pilot study.
OBJECTIVE
This study was designed to investigate whether the addition of N-terminal pro-B-type natriuretic peptide-guided, intensive patient management (BM) to multidisciplinary care (MC) improves outcome in patients following hospitalization due to heart failure (HF).


BACKGROUND
Patients hospitalized due to HF experience frequent rehospitalizations and high mortality.


METHODS
Patients hospitalized due to HF were randomized to BM, MC, or usual care (UC). Multidisciplinary care included 2 consultations from an HF specialist who provided therapeutic recommendations and home care by a specialized HF nurse. In addition, BM included intensified up-titration of medication by HF specialists in high-risk patients. NT-proBNP was used to define the level of risk and to monitor wall stress. This monitoring allowed for anticipation of cardiac decompensation and adjustment of medication in advance.


RESULTS
A total of 278 patients were randomized in 8 Viennese hospitals. After 12 months, the BM group had the highest proportion of antineurohormonal triple-therapy (difference among all groups). Accordingly, BM reduced days of HF hospitalization (488 days) compared with the hospitalization for the MC (1,254 days) and UC (1,588 days) groups (p < 0.0001; significant differences among all groups). Using Kaplan-Meier analysis, the first HF rehospitalization (28%) was lower in the BM versus MC groups (40%; p = 0.06) and the MC versus UC groups (61%; p = 0.01). Moreover, the combined end point of death or HF rehospitalization was lower in the BM (37%) than in the MC group (50%; p < 0.05) and in the MC than in the UC group (65%; p = 0.04). Death rate was similar between the BM (22%) and MC groups (22%), but was lower compared with the UC group (39%; vs. BM: p < 0.02; vs. MC: p < 0.02).


CONCLUSIONS
Compared with MC alone, additional BM improves clinical outcome in patients after HF hospitalization. (BNP Guided Care in Addition to Multidisciplinary Care; NCT00355017).
Berger
Rudolf
R
Department of Cardiology, Medical University of Vienna, Vienna, Austria. rudolf.berger@meduniwien.ac.at <rudolf.berger@meduniwien.ac.at>
Moertl
Deddo
D
Peter
Sieglinde
S
Ahmadi
Roozbeh
R
Huelsmann
Martin
M
Yamuti
Susan
S
Wagner
Brunhilde
B
Pacher
Richard
R
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001317:Austria; D002309:Cardiology; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009819:Office Visits / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D010446:Peptide Fragments / Q000097:blood*; D010865:Pilot Projects; D011320:Primary Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D018570:Risk Assessment; D013041:Specialties, Nursing; D013148:Spironolactone / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D013148:Spironolactone; D005665:Furosemide