NT-proBNP–guided and clinically guided treatment reduced short-term but not long-term mortality in chronic HF

Randomized controlled trial (NT-proBNP-Assisted Treatment To Lessen Serial Cardiac Readmissions and Death [BATTLESCARRED] trial). Australian New Zealand Clinical Trials Registry ACTRN 12605000735651.

Unclear allocation concealment.*

Blinded ({patients}† and outcome assessors).*

3 years.

Primary care clinic in Christchurch, New Zealand.

364 patients > 18 years of age (median age 75 to 76 y, 64% men) who were hospitalized for symptomatic chronic HF (Framingham criteria and European Society of Cardiology diagnostic guidelines) and had an immediate prerandomization plasma NT-proBNP level > 50 pmol/L (about 400 pg/mL). Exclusion criteria were active myocarditis or pericarditis; severe hepatic or pulmonary disease (FEV₁ < 1 L), renal impairment (plasma creatinine > 250 µmol/L), or valvular disease; eligibility for cardiac transplantation; and life expectancy < 24 months because of noncardiovascular disease.

121 patients were allocated to NT-proBNP–guided treatment with medication adjustments and additional follow-up triggered by NT-proBNP levels > 150 pmol/L or HF scores ≥ 2.0. 121 were allocated to CG treatment targeted to trial-based doses of the equivalent of enalapril, 10 mg twice daily, adjusted for renal function, and β-blockers (carvedilol titrated to 25 mg twice daily or sustained-release metoprolol titrated to 190 mg/d). CG treatment was intensified for HF scores ≥ 2.0. 122 were allocated to UC with management in primary care practices.

Included all-cause mortality.

87% (intention to treat).

NT-proBNP–guided and CG treatment each reduced mortality more than did UC at 1 year (9.1% vs 9.1% vs 18.9%, P = 0.03 for both comparisons); groups did not differ for mortality in unadjusted analyses at 3 years (33.1% vs 33.1% vs 32.8%). In prespecified subgroup analyses at 3 years, NT-proBNP–guided treatment reduced mortality in patients ≤ 75 years of age (Table) but not those > 75 years of age (49% vs 35% vs 34%, P ≤ 0.025 for interaction).

NT-proBNP–guided and clinically guided treatment each reduced short-term but not long-term mortality more than usual primary care in chronic heart failure.