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PRIMA: NT-proBNP measurement increased HF medication use but not survival rate outside hospital setting
Eurlings L. J Am Coll Cardiol. 2010;56:2090-2100.
Troughton R. J Am Coll Cardiol. 2010;56:2101-2104.
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Measuring N-terminal pro-B-type natriuretic peptide in patients with HF advanced detection of HF-related events and influenced therapy, but it did not produce a significant improvement on the number of days of survival outside the hospital, study results indicated.
The PRIMA trial was conducted in 12 Dutch university and general hospitals. All patients (n=345) were hospitalized for decompensated, symptomatic HF, including elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at admission. After discharge, patients were randomly assigned to either clinically guided outpatient management (n=171) or management guided by an individually set NT-proBNP (n=174).
Researchers reported that management guided by an individualized NT-proBNP target did not significantly improve the primary endpoint of number of days alive outside the hospital (685 days vs. 664; P=.49), despite increasing the use of HF medication (P=.006) and detecting 64% of the imminent HF-related events. Patients in the NT-proBNP-guided group experienced nonstatistically significant lower rates of mortality compared with the clinically guided group (26.5% vs. 33.3%), whereas there were no differences between the total number of CV and HF-related admissions between groups.
These findings, the researchers concluded, show that unstable NT-proBNP levels indicate imminent events, although intensification of currently used medication in patients on optimal HF therapy does not prevent further deterioration.
In an editorial accompanying the study, Richard W. Troughton, MB ChB, PhD, Chris M. Frampton, PhD, and M. Gary Nicholls, MD, said the findings of PRIMA are important additions to the series of biomarker-guided HF studies.
“Use of a single target level of BNP or NT-proBNP, perhaps adjusted for clinical covariates such as age, appears to offer the best opportunity for the biomarker-guided strategy to alter management. As is the case for their use as diagnostic markers, changes in serial BNP and NT-proBNP levels should be interpreted within the entire clinical context, including reference to other tests, such as those for renal function,” they wrote.
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