STOP-HF: BNP-based screening, collaborative care decreased HF rate

Collaborative care based on screening for brain-type natriuretic peptide reduced combined rates of left ventricular systolic dysfunction, diastolic dysfunction and HF in at-risk patients, according to results from the STOP-HF trial.

“This is a ‘first of type’ study where the brain-type natriuretic peptide (BNP) was used to define risk more effectively than standard risk indicators. In those where the test indicated high risk, intervention — comprised of a multidimensional approach to care between the general practitioner and a specialist cardiologist focusing on more intensive cardiovascular investigations and focusing on risk factor control — was shown to reduce risk of subsequent major cardiovascular events, defined as hospitalization for cardiovascular causes,” study researcher Kenneth McDonald, MD, director of the heart failure unit at St. Vincent’s University Hospital in Dublin, told Cardiology Today.

Kenneth McDonald

Results from STOP-HF were previously reported at the American College of Cardiology Scientific Sessions 2013.

Benefits of BNP screening

McDonald and researchers from the St. Vincent’s Healthcare Group/St. Michael’s Hospital in Dublin recruited 1,374 participants (mean age, 64.8 years) with CV risk factors from 39 primary care practices in Ireland from 2005 to 2009. They randomly assigned participants to usual primary care (n=677) or screening with BNP testing (n=697). Those in the intervention group with BNP levels ≥50 pg/mL underwent echocardiography and received collaborative care between their primary care physician and specialist CV service. Mean follow-up was 4.2 years.

Of those in the intervention group, 263 (41.6%) had at least one BNP reading ≥50 pg/mL. The primary endpoint of LV dysfunction with or without HF occurred in 59 participants (8.7%) in the control group vs. 37 (5.3%) in the intervention group (OR=0.55; 95% CI, 0.37-0.82). The researchers found asymptomatic LV dysfunction in 45 participants (6.6%) in the control group vs. 30 (4.3%) in the intervention group (OR=0.57; 95% CI, 0.37-0.88). Fourteen (2.1%) and seven (1%) participants in the control and intervention groups, respectively, experienced HF (OR=0.48; 95% CI, 0.2-1.20).

Incidence rates of emergency hospitalization for major CV events were 40.4 per 1,000 patient-years in the control group vs. 22.3 per 1,000 patient-years in the intervention group (incidence rate ratio=0.6; 95% CI, 0.45-0.81).

Results also indicated that participants in the intervention group underwent more CV investigations (850 per 1,000 patient-years) when compared with the control group (496 per 1,000 patient-years), with an incidence rate ratio of 1.71 (95% CI, 1.61-1.83). They also received more renin-angiotensin-aldosterone system-based therapy at follow-up than control participants (56.5% vs. 49.6%; P=.01).

“This is a large study, but it was completed in only one region in one country, so [the findings] need to be confirmed,” McDonald said. “However, the observation that BNP defines risk is well known and one could argue that this blood test should be used to differentiate risk as we have done within a large cohort.”

Future research

Adrian F. Hernandez, MD, MHS, of the Duke Clinical Research Institute and department of medicine at the Duke University School of Medicine, said the researchers for STOP-HF have “[taken] one step toward the goal of preventing heart failure.”

“Moving forward, lessons from the STOP-HF trial can help improve heart failure prevention strategies and inform approaches for similar trials,” Hernandez wrote in an accompanying editorial.

“Hopefully, to achieve the goal of preventing heart failure, more studies like STOP-HF will be conducted, except with thousands of patients, across hundreds of sites, in half the time, and with a focus on outcomes that are most important for patients.”

For more information:

Hernandez AF. JAMA. 2013;310:44-45.

Ledwidge M. JAMA. 2013;310:66-74.

Disclosure: See the study for a full list of disclosures. Hernandez reports receiving research support and/or honoraria from Bristol-Myers Squibb, Corthera, Janssen and Portola Pharmaceuticals.