Faculty Collaboration Database

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. J Card Fail 2012 Aug;18(8):626-34

Date

08/04/2012

Pubmed ID

22858078

DOI

10.1016/j.cardfail.2012.05.005

Scopus ID

2-s2.0-84864453622 (requires institutional sign-in at Scopus site)   67 Citations

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.

METHODS AND 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).

Author List

Gaggin HK, Mohammed AA, Bhardwaj A, Rehman SU, Gregory SA, Weiner RB, Baggish AL, Moore SA, Semigran MJ, Januzzi JL Jr

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Aged, 80 and over
Aging
Antihypertensive Agents
Disease Progression
Female
Heart Failure
Humans
Male
Middle Aged
Natriuretic Peptide, Brain
Outpatients
Peptide Fragments
Prognosis
Statistics as Topic
Treatment Outcome
Ultrasonography
Ventricular Dysfunction, Left