Clinical Research
Heart Failure
N-Terminal Pro–B-Type Natriuretic Peptide–Guided, Intensive Patient Management in Addition to Multidisciplinary Care in Chronic Heart Failure: A 3-Arm, Prospective, Randomized Pilot Study

https://doi.org/10.1016/j.jacc.2009.08.078Get rights and content
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Objectives

This study was designed to investigate whether the addition of N-terminal pro–B-type natriuretic peptide–guided, intensive patient management (BM) to multidisciplinary care (MC) improves outcome in patients following hospitalization due to heart failure (HF).

Background

Patients hospitalized due to HF experience frequent rehospitalizations and high mortality.

Methods

Patients hospitalized due to HF were randomized to BM, MC, or usual care (UC). Multidisciplinary care included 2 consultations from an HF specialist who provided therapeutic recommendations and home care by a specialized HF nurse. In addition, BM included intensified up-titration of medication by HF specialists in high-risk patients. NT-proBNP was used to define the level of risk and to monitor wall stress. This monitoring allowed for anticipation of cardiac decompensation and adjustment of medication in advance.

Results

A total of 278 patients were randomized in 8 Viennese hospitals. After 12 months, the BM group had the highest proportion of antineurohormonal triple-therapy (difference among all groups). Accordingly, BM reduced days of HF hospitalization (488 days) compared with the hospitalization for the MC (1,254 days) and UC (1,588 days) groups (p < 0.0001; significant differences among all groups). Using Kaplan-Meier analysis, the first HF rehospitalization (28%) was lower in the BM versus MC groups (40%; p = 0.06) and the MC versus UC groups (61%; p = 0.01). Moreover, the combined end point of death or HF rehospitalization was lower in the BM (37%) than in the MC group (50%; p < 0.05) and in the MC than in the UC group (65%; p = 0.04). Death rate was similar between the BM (22%) and MC groups (22%), but was lower compared with the UC group (39%; vs. BM: p < 0.02; vs. MC: p < 0.02).

Conclusions

Compared with MC alone, additional BM improves clinical outcome in patients after HF hospitalization. (BNP Guided Care in Addition to Multidisciplinary Care; NCT00355017)

Key Words

chronic heart failure
multidisciplinary care
nurse
natriuretic peptide

Abbreviations and Acronyms

ACE-I
angiotensin-converting enzyme inhibitor
BM
N-terminal pro–B-type natriuretic peptide-guided, intensive patient management
BNP
B-type natriuretic peptide
CHF
chronic heart failure
HF
heart failure
MC
multidisciplinary care
NP
natriuretic peptide
NT-proBNP
N-terminal pro–B-type natriuretic peptide
UC
usual care

Cited by (0)

This study was funded by AstraZeneca, Novartis, Roche Diagnostics, Roche Medical, Merck, Medtronic, and Guidant, who provided the financial support for a clinical investigator, a specialized chronic heart failure nurse, and data collection.