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.
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Wesorick DH, Chopra V. Annals for Hospitalists - 21 February 2017. Ann Intern Med. ;166:HO1. doi: 10.7326/AFHO201702210
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Published: Ann Intern Med. 2017;166(4):HO1.
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