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BATTLESCARRED: NT-proBNP-guided therapy improves mortality in older patients with chronic HF
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The implementation of a hormone-guided treatment strategy guided by N-terminal pro-B-type natriuretic peptide levels selectively improved longer-term mortality in patients 75 years and older with chronic HF.
BATTLESCARRED study researchers enrolled 364 patients admitted to the hospital with HF and randomly assigned them at a 1:1:1 ratio to receive either therapy guided by NT-proBNP levels (n=121), intensive clinical management (n=121) or usual care (n=122). Treatment strategies were applied for two years with a follow-up of three years. The primary study outcomes included all-cause mortality and a composite of death plus hospitalization or HF.
One-year mortality was less in both the NT-proBNP group (9.1%) and the intensive clinical management group (9.1%) vs. the usual care group (18.9%, P=.03). In patents ≤75 years of age, NT-proBNP-guided therapy was associated with reduced three-year mortality (15.5%) when compared with either intensive clinical management (30.9%, P=.048) or usual care (31.3%, P=.021). Overall hospitalizations for HF did not differ between the study groups, and there were no differences in the secondary outcomes of death plus hospital admission from any CV event or total hospital admissions.
“We have shown that compared with usual care in the community, intensive management with or without guidance from serial measurements of plasma NT-proBNP improves mortality at one year among patients with chronic HF,” the researchers wrote. “Hormone-guided treatment was associated with a lower mortality rate (and also reduced mortality plus hospitalization rate) at three years compared with either intensive clinical management or usual care for patients ≤75 years of age.”
In an accompanying editorial, Alan Maisel, MD, a cardiologist at the Department of Veterans Affairs Medical Center in San Diego, asserted that while natriuretic peptide levels may not be fully ready for “prime time” as guides for HF therapy, the BATTLESCARRED researchers have provided grounds to further explore their potential role.
“Targeting the abnormal biology of HF is crucial to reduce the considerable risk we are seeing with this disease – at the end of the day, we in cardiology must begin to embrace the concept of biologically-guided treatment of our patients with HF,” he wrote. “Although caveats exist, the BATTLESCARRED study points us in a direction. Future studies will need to continue down this path, which is one that we must take.”
Lainchbury J. J Am Coll Cardiol. 2009;55:53-60.