title: Quality of life and chronic heart failure therapy guided by natriuretic peptides: results from the ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) study.
abstract: BACKGROUND
  Heart failure (HF) treatment guided by amino-terminal pro-B type natriuretic peptide (NT-proBNP) may reduce cardiovascular event rates compared to standard-of-care (SOC) management. Comprehensive understanding regarding effect of NT-proBNP guided care on patient-reported quality of life (QOL) remains unknown.
  
  
  METHODS
  One hundred fifty-one subjects with HF due to left ventricular systolic dysfunction were randomized to either SOC HF management or care with a goal to reduce NT-proBNP values ≤1000 pg/mL. Effects of HF on QOL were assessed using the Minnesota Living with HF Questionnaire (MLHFQ) quarterly, with change (Δ) in score assessed across study procedures and as a function of outcome.
  
  
  RESULTS
  Overall, baseline MLHFQ score was 30. Across study visits, QOL improved in both arms, but was more improved and sustained in the NT-proBNP arm (repeated measures P = .01); NT-proBNP patients showing greater reduction in MLHFQ score (-10.0 vs -5.0; P = .05), particularly in the physical scale of the questionnaire. Baseline MLHFQ scores did not correlate with NT-proBNP; in contrast, ∆MLHFQ scores modestly correlated with ∆NT-proBNP values (ρ = .234; P = .006) as did relative ∆ in MLHFQ score and NT-proBNP (ρ = .253; P = .003). Considered in tertiles, less improvement in MLHFQ scores was associated with a higher rate of HF hospitalization, worsening HF, and cardiovascular death (P = .001).
  
  
  CONCLUSIONS
  We describe novel associations between NT-proBNP concentrations and QOL scores among patients treated with biomarker guided care. Compared to SOC HF management, NT-proBNP guided care was associated with greater and more sustained improvement in QOL (Clinical Trial Registration: www.clinicaltrials.govNCT00351390).
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Anju
authors.initials: A
authors.lastname: Bhardwaj
authors.forename: Shafiq U
authors.initials: SU
authors.lastname: Rehman
authors.forename: Asim A
authors.initials: AA
authors.lastname: Mohammed
authors.forename: Hanna K
authors.initials: HK
authors.lastname: Gaggin
authors.forename: Linda
authors.initials: L
authors.lastname: Barajas
authors.forename: Justine
authors.initials: J
authors.lastname: Barajas
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Moore
authors.forename: Dorothy
authors.initials: D
authors.lastname: Sullivan
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D054143:Heart Failure, Systolic / Q000097:blood* / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000187:drug effects; D010446:Peptide Fragments / Q000097:blood* / Q000187:drug effects; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D002317:Cardiovascular Agents; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D004077:Digoxin