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HABIT: Home B-natriuretic peptide testing feasible
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Measuring daily B-type natriuretic peptide levels in at-risk HF patients is feasible and may reduce hospital readmissions and improve clinical outcomes, according to study results.
Researchers from the pilot HABIT trial studied 163 patients with HF signs and symptoms of acute clinical HF decompensation discharged from the hospital or in an outpatient. Weight and B-type natriuretic peptide levels with a finger-stick test (Alere Heart Check) were measured daily for 60 days. Patients and physicians were masked to B-type natriuretic levels. The primary endpoint was a composite of any of the following acute clinical HF decompensation events up to 5 days after testing: CV death, admission for decompensated HF, clinical HF decompensation requiring either parenteral HF therapy or changes in oral HF medicine.
Alan Maisel
Researchers recorded 6,934 daily B-type natriuretic peptide values (median of 46 measures per patient) during a 65-day period; 40 patients had 56 events. As correlations between B-type natriuretic peptides measures weakened over time, dispersion between B-type natriuretic peptides increased.
During more than 10,000 patient-days of follow-up, researchers recorded 494 days of weight gain (≥5 lb) and 710 days of acute B-type natriuretic peptide rise (more than double in 3 days). The effects of weight gain (HR=3.63; 95% CI, 1.83-7.20) and B-type natriuretic increase (HR=1.84; 95% CI, 1.42-2.39) was significant when controlling for symptoms.
In intervals based on acute clinical HF decompensation events, there were 39 (18.4%) intervals of upward trending B-type natriuretic peptide corresponding to a risk increase for 59.8% and 64 downward trending intervals corresponding to a risk increase for 39%. In total, there were 94 (44.3%) intervals with 1 or more days of weight gain corresponding to a risk increase of 26.1%, according to study data in the Journal of the American College of Cardiology.
“This pilot study demonstrates that home B-type natriuretic peptide testing is feasible and that trials using home monitoring for guiding therapy are justifiable in high-risk patients,” Alan Maisel, MD, professor of medicine at Veterans Affairs Medical Center, San Diego, and colleagues wrote. “Daily weight monitoring is complementary to B-type natriuretic peptide, but B-type natriuretic peptide changes correspond to larger changes in risk, both upward and downward.”
For more information:
Maisel A. J Am Coll Cardiol. 2013;61:1726-1735.
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.
Perspective
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Frank Smart, MD
The study is well done and supports the hypothesis that it is possible for patients to monitor B-type natriuretic peptide at home. It also indicates that, in this pilot study, the B-type natriuretic peptide levels were helpful in the clinical management of HF when added to weight measurements.
The researchers believe a large clinical trial to further assess the clinical utility of such measurements is warranted. The study does not support the routine use of this test at home. This type of conclusion in a high-risk population will require a large number of patients followed for an extended period of time. In addition, an economic benefit analysis will need to be performed in the study population to determine the financial impact such a management strategy would have on the cost of HF care.
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