title: The STARBRITE trial: a randomized, pilot study of B-type natriuretic peptide-guided therapy in patients with advanced heart failure.
abstract: BACKGROUND
  STARBRITE, a multicenter randomized pilot trial, tested whether outpatient diuretic management guided by B-type natriuretic peptide (BNP) and clinical assessment resulted in more days alive and not hospitalized over 90 days compared with clinical assessment alone.
  
  
  RESULTS
  A total of 130 patients from 3 sites with left ventricular ejection fraction ≤35% were enrolled during hospitalization for heart failure (HF) and randomly assigned to therapy guided by BNP and clinical assessment (BNP strategy) or clinical assessment alone. The clinical goal was resolution of congestion without hypotension or renal dysfunction. In the BNP arm, therapy was adjusted to achieve optimal fluid status, defined as the BNP level and congestion score obtained at the time of discharge. In the clinical assessment arm, therapy was titrated to achieve optimal fluid status, represented by the patient's signs and symptoms at the time of discharge. Exclusion criteria were serum creatinine >3.5 mg/dL and acute coronary syndrome. Follow-up was done in HF clinics. BNP was measured with the use of a rapid assay test. There was no significant difference in number of days alive and not hospitalized (hazard ratio 0.72, 95% confidence interval 0.41-1.27; P = .25), change in serum creatinine, or change in systolic blood pressure (SBP). BNP strategy was associated with a trend toward a lower blood urea nitrogen (24 mg/dL vs 29 mg/dL; P = .07); BNP strategy patients received significantly more angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and the combination of ACE inhibitor or angiotensin receptor blocker plus beta-blockers.
  
  
  CONCLUSIONS
  BNP strategy was not associated with more days alive and not hospitalized, but the strategy appeared to be safe and was associated with increased use of evidence-based medications.
authors.affiliation: Duke University Medical Center, USA.
authors.forename: Monica R
authors.initials: MR
authors.lastname: Shah
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Anju
authors.initials: A
authors.lastname: Nohria
authors.forename: Manju
authors.initials: M
authors.lastname: Bhapkar
authors.forename: Margaret
authors.initials: M
authors.lastname: Bowers
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.forename: Mona
authors.initials: M
authors.lastname: Fiuzat
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage* / Q000097:blood; D010865:Pilot Projects; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D020097:Natriuretic Peptide, Brain