David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
Hospitalized HF patients who reach threshold NP levels before discharge have better outcomes.
Threshold NP levels varied among the studies. Twenty-seven of the BNP studies used absolute BNP threshold levels (most commonly 250 pg/mL or less, but ranging from 165 pg/mL to 992.6 pg/mL). Nine of the BNP studies used a threshold based on a percentage reduction from the admission value (ranging from 30% to 64% reduction).
An editorial http://annals.org/aim/article/2588750 highlights how previous randomized, controlled trials have not been able to demonstrate any benefit with a “treat-to-target” approach. The editorialists thus suggest that, while the findings are intriguing, there is still more to learn about the role of NP measurement in the care of ADHF patients.
Although the strength of the evidence is low, the authors suggest that metformin may improve important clinical outcomes in some subgroups of patients that were previously believed to have contraindications to its use.
The study supports the recent changes in metformin recommendations from the U.S. Food and Drug Administration. CHF was removed as a contraindication (although acute or unstable CHF remains a precaution), and the GFR restriction was reduced to <30 mL/min/1.73 m2.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Wesorick DH, Chopra V. Annals for Hospitalists - 21 February 2017. Ann Intern Med. ;166:HO1. doi: 10.7326/AFHO201702210
Download citation file:
Published: Ann Intern Med. 2017;166(4):HO1.
Copyright © 2018 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use