N-BNP levels to guide heart failure treatment

This trial investigated whether measurement of amino-terminal brain natiuretic peptide (N-BNP) concentrations permitted more effective treatment of heart failure when compared to standard clinical practice.

Standardised heart failure scoring methods use symptoms and signs to assess whether a patient's treatment is adequate.

N-BNP is a fragment of BNP which is released from the left ventricular wall in response to increased stretch. There is a correlation between deteriorating heart failure and increasing N-BNP concentrations.

This double-blind study enrolled 69 patients with an left ventricular ejection fraction of <40% and a class II-IV NYHA heart failure. 33 were randomised to have treatment guided by N-BNP levels and 36 were randomised to have treatment guided by clinical assessment. Doctors who assessed the patients were not aware of which group a patient had been assigned to.

The primary end-point was total cardiovascular events:

• cardiovascular death
• admission for cardiovascular disease
• decompensation of heart failure not requiring admission

Median follow-up was 9.5 months.

Reference:

• 1) Troughton, RW, Frampton, CM. et al. (2000). Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet, 355, 1126-30.