[Usefulness of brain natriuretic peptide levels, as compared with usual clinical control, for the treatment monitoring of patients with heart failure].
OBJECTIVE
Chronic heart failure continues to have a poor prognosis, in spite of advances made in its therapy. It is uncertain whether symptom-guided therapy optimization is the most effective strategy in this setting. The aim of our study was to evaluate the usefulness of a brain natriuretic peptide (BNP)-guided therapy for the treatment of patients with heart failure.


METHODS
We carried out a prospective and randomized study including 60 patients consecutively discharged with the diagnosis of heart failure NYHA class III or IV in one cardiology department of a Spanish hospital; 30 patients were randomly assigned to a symptom-guided therapy group based on the clinical Framingham score, and 30 to a BNP-guided therapy group. Therapy was adjusted to obtain a clinical score <2 in the symptom-guided group and BNP levels <100pg/ml in the BNP-guided group. Follow up was 16±4 months.


RESULTS
BNP-guided group had lower BNP levels during follow up than had symptom-guided group: 14(20)pg/ml versus 111±71pg/ml at 18 months, p=0.029. Clinical score was similar in both groups: 0.42(0.33) versus 0.39(0.63) at 18 months. Probability of survival (86% in both groups) and probability of being free of readmissions for heart failure (68 versus 66%) at 18 months were similar in both groups.


CONCLUSIONS
In our experience, in patients with heart failure, BNP-guided therapy did not improve clinical outcomes compared with symptom-guided therapy.
Anguita
Manuel
M
Servicio de Cardiología, Hospital Reina Sofía, Córdoba, España. manuelp.anguita.sspa@juntadeandalucia.es
Esteban
Fátima
F
Castillo
Juan C
JC
Mazuelos
Francisco
F
López-Granados
Amador
A
Arizón
José M
JM
Suárez De Lezo
José
J
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies
D020097:Natriuretic Peptide, Brain