Use of biomarker did not lead to clinical benefit in patients with chronic HF

American College of Cardiology 60th Annual Scientific Sessions

NEW ORLEANS — Measurements of N-terminal pro–B-type natriuretic peptide levels in high-risk patients with chronic HF was not beneficial and produced only a neutral outcome, according to newly-published clinical research.

“For 10 years, N-terminal pro–B-type natriuretic peptide (NT-proBNP) monitoring has been debated, so we tried to make a proof-of-concept study for NT-proBNP monitoring,” Morten Schou, MD, PhD, the study’s principal investigator and cardiology fellow at Hillerød University Hospital in Denmark, said during a press conference.

Schou and researchers of this multicenter, randomized trial analyzed 1,120 clinically stable patients who had at least one visit to an HF clinic in Denmark in the randomization period. Patients were split into five arms according to risk level determined by NT-proBNP levels. These included low-risk patients (<1,000 pg/mL) managed by a general practitioner (n=257) or an HF clinic (n=253), or high-risk patients (>1,000 pg/mL) managed by a general practitioner (n=203), an HF clinic for standard follow-up (n=208) or an HF clinic for biomarker monitoring (n=199).

After a median of 2.8 years, the primary endpoint — a composite of hospitalization for a CV event and death — did not differ significantly between patients in the HF clinic (events=177) or the general practitioner (events=159; trend P=.145) groups, which remained consistent regardless of risk status. Specifically, low-risk patients in the general practitioner arm had 27 deaths and 81 composite events, whereas 22 deaths and 92 composite events were reported in the HF clinic group. For high-risk patients, there were 37 deaths and 78 composite events in the general practitioner group vs. 38 deaths and 85 events in the HF clinic and 46 deaths and 92 events in the HF clinic plus monitoring groups.

According to Schou, this study provided answers to two important questions.

“Do optimized HF patients who are clinically stable need to be followed by a cardiologist and a HF nurse? The answer is no,” he said. “And second, can NT-proBNP identify high-risk patients? The answer is clearly yes, but the intervention did not improve outcome for the patients.”

For more information:

Schou M. Session 3016. Presented at:ACC 60^th Annual Scientific Sessions; April 2-5, 2011; New Orleans.

Disclosure: Dr. Schou has received research grants from Roche Diagnostics International and Merck Sharp & Dohme.

Follow CardiologyToday.com on Twitter.