title: Heart failure outcomes and benefits of NT-proBNP-guided management in the elderly: results from the prospective, randomized ProBNP outpatient tailored chronic heart failure therapy (PROTECT) study.
abstract: BACKGROUND
  Elderly patients with heart failure (HF) have a worse prognosis than younger patients. We wished to study whether elders benefit from natriuretic peptide-guided HF care in this single-center study.
  
  
  RESULTS
  A total of 151 patients with HF resulting from left ventricular systolic dysfunction (LVSD) were treated with HF treatment by standard-of-care (SOC) management or guided by N-terminal pro-B type natriuretic peptide (NT-proBNP) values (with a goal to lower NT-proBNP ≤1000 pg/mL) over 10 months. The primary end point for this post-hoc analysis was total cardiovascular events in 2 age categories (<75 and ≥75 years). In those ≥75 years of age (n = 38), NT-proBNP values increased in the SOC arm (2570 to 3523 pg/mL, P = .01), but decreased in the NT-proBNP-guided arm (2664 to 1418 pg/mL, P = .001). Elderly patients treated with SOC management had the highest rate of cardiovascular events, whereas the elderly with NT-proBNP management had the lowest rate of cardiovascular events (1.76 events per patient versus 0.71 events per patient, P = .03); the adjusted logistic odds for cardiovascular events related to NT-proBNP-guided care for elders was 0.24 (P = .008), whereas in those <75 years (n = 113), the adjusted logistic odds for events following NT-proBNP-guided care was 0.61 (P = .10).
  
  
  CONCLUSIONS
  Natriuretic peptide-guided HF care was well tolerated and resulted in substantial improvement in cardiovascular event rates in elders (ClinicalTrials.Gov #00351390).
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Hanna K
authors.initials: HK
authors.lastname: Gaggin
authors.forename: Asim A
authors.initials: AA
authors.lastname: Mohammed
authors.forename: Anju
authors.initials: A
authors.lastname: Bhardwaj
authors.forename: Shafiq U
authors.initials: SU
authors.lastname: Rehman
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Gregory
authors.forename: Rory B
authors.initials: RB
authors.lastname: Weiner
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Baggish
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Moore
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Semigran
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010045:Outpatients; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D013223:Statistics as Topic; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000473:pathology
chemical_list: D000959:Antihypertensive Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain