Bertram Pitt, MD
After hospitalization for heart failure (HF), does adding N-terminal pro-B-type natriuretic peptide (NT-proBNP)–guided management to multidisciplinary care reduce risk for death or HF rehospitalization?
Randomized controlled trial (RCT). ClinicalTrials.gov NCT00355017.
Blinded (outcome assessors).*
12 to 18 months after discharge.
8 hospitals in Vienna, Austria.
278 patients (mean age 71 y, 65% men) hospitalized with clinical signs and symptoms of cardiac decompensation, New York Heart Association functional class III or IV, and left ventricular ejection fraction (LVEF) < 40% or cardiothoracic ratio > 0.5.
NT-proBNP–guided management (BM) (n = 92), multidisciplinary care (MC) (n = 96), or usual care (UC) (n = 90), upon discharge. BM comprised MC plus NT-proBNP level-driven HF specialist visits. If the discharge NT-proBNP level was > 2200 pg/mL, HF specialist visits occurred at least every 2 weeks. If high levels continued, biweekly visits continued until the maximal recommended or tolerated doses of HF therapy were established, after which the interval between visits was increased to every 3 months. If the NT-proBNP level decreased to < 2200 pg/mL at 3 or 6 months, patients were followed as in the MC group. MC comprised 4 home visits and telephone contact by a specialized HF nurse and 2 consultations with a HF specialist, plus additional consultations as needed. UC comprised care by the patient’s primary care physician who was asked to implement the discharge management plan.
Included days of HF rehospitalization, death, HF rehospitalization, and mortality plus HF rehospitalization.
100% (intention-to-treat analysis).
The main results are in the Table.
After hospitalization for heart failure (HF), adding N-terminal pro-B-type natriuretic peptide–guided management to multidisciplinary care reduced days of HF rehospitalization and combined HF rehospitalization and death but not HF rehospitalization or death alone.
N-terminal pro-B-type natriuretic peptide–guided management (BM) vs multidisciplinary care (MC) vs usual care (UC) after heart failure (HF) hospitalization†
†NS = not significant.
‡Kaplan-Meier analyses with log-rank tests were calculated for comparison of time-dependent outcomes.
Pitt B. Adding NT-proBNP–guided management to multidisciplinary care reduced heart failure rehospitalization days. Ann Intern Med. 2010;153:JC1–8. doi: 10.7326/0003-4819-153-2-201007200-02008
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Published: Ann Intern Med. 2010;153(2):JC1-8.
Cardiology, Heart Failure.
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