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CLINICAL RESEARCH: HEART FAILURE

N-Terminal Pro–B-Type Natriuretic Peptide-Guided Treatment for Chronic Heart Failure

Results From the BATTLESCARRED (NT-proBNP–Assisted Treatment To Lessen Serial Cardiac Readmissions and Death) Trial

Department of Medicine, Christchurch Cardioendocrine Research Group, University of Otago, Christchurch, New Zealand

Manuscript received November 26, 2008; revised manuscript received February 19, 2009, accepted February 24, 2009.

^_* Reprint requests and correspondence: Dr. A. Mark Richards, The Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, P.O. Box 4345, Christchurch 8140, New Zealand (Email: mark.richards{at}cdhb.govt.nz).

Objectives: The purpose of this study was to compare the effects of N-terminal pro–B-type natriuretic peptide (NT-proBNP)-guided therapy with those of intensive clinical management and with usual care (UC) on clinical outcomes in chronic symptomatic heart failure.

Background: Initial trial results suggest titration of therapy guided by serial plasma B-type natriuretic peptide levels improves outcomes in patients with chronic heart failure, but the concept has not received widespread acceptance. Accordingly, we conducted a longer-term study comparing the effects of NT-proBNP–guided therapy with those of intensive clinical management and with UC of patients with heart failure.

Methods: Three hundred sixty-four patients admitted to a single hospital with heart failure were randomly allocated 1:1:1 (stratified by age) to therapy guided by NT-proBNP levels or by intensive clinical management, or according to UC. Treatment strategies were applied for 2 years with follow-up to 3 years.

Results: One-year mortality was less in both the hormone- (9.1%) and clinically-guided (9.1%) groups compared with UC (18.9%; p = 0.03). Three-year mortality was selectively reduced in patients 75 years of age receiving hormone-guided treatment (15.5%) compared with their peers receiving either clinically managed treatment (30.9%; p = 0.048) or UC (31.3%; p = 0.021).

Conclusions: Intensive management of chronic heart failure improves 1-year mortality compared with UC. Compared with clinically guided treatment and UC, hormone-guided treatment selectively improves longer-term mortality in patients 75 years of age. (NT-proBNP–Assisted Treatment To Lessen Serial Cardiac Readmissions and Death [BATTLESCARRED]; Australian New Zealand Clinical Trials Registry 12605000735651)

Key Words: NT-proBNP • chronic heart failure • survival

Abbreviations and Acronyms   ACEI = angiotensin-converting enzyme inhibitor   ARB = angiotensin receptor blocker   BB = beta-adrenergic blocker   BNP = B-type natriuretic peptide   CG = clinically guided   CHF = chronic heart failure   LVEF = left ventricular ejection fraction   NT-proBNP = N-terminal pro–B-type natriuretic peptide   NYHA = New York Heart Association   UC = usual care

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