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CLINICAL RESEARCH: HEART FAILURE

N-Terminal Pro–B-Type Natriuretic Peptide–Guided, Intensive Patient Management in Addition to Multidisciplinary Care in Chronic Heart Failure

A 3-Arm, Prospective, Randomized Pilot Study

Rudolf Berger, MD^_*,_*, Deddo Moertl, MD^_*, Sieglinde Peter, RN^_*, Roozbeh Ahmadi, MD^_*, Martin Huelsmann, MD^_*, Susan Yamuti, RN, Brunhilde Wagner, MD and Richard Pacher, MD^_*

^_* Department of Cardiology, Medical University of Vienna, Vienna, Austria
Department of Cardiology, Hospital of Hietzing, Vienna, Austria
Department of Cardiology, Hospital Sozialmedizinisches Zentrum Ost, Vienna, Austria

Manuscript received November 13, 2008; revised manuscript received July 6, 2009, accepted August 31, 2009.

^_* Reprint requests and correspondence: Dr. Rudolf Berger, Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria (Email: rudolf.berger{at}meduniwien.ac.at).

Objectives: This study was designed to investigate whether the addition of N-terminal pro–B-type natriuretic peptide–guided, intensive patient management (BM) to multidisciplinary care (MC) improves outcome in patients following hospitalization due to heart failure (HF).

Background: Patients hospitalized due to HF experience frequent rehospitalizations and high mortality.

Methods: Patients hospitalized due to HF were randomized to BM, MC, or usual care (UC). Multidisciplinary care included 2 consultations from an HF specialist who provided therapeutic recommendations and home care by a specialized HF nurse. In addition, BM included intensified up-titration of medication by HF specialists in high-risk patients. NT-proBNP was used to define the level of risk and to monitor wall stress. This monitoring allowed for anticipation of cardiac decompensation and adjustment of medication in advance.

Results: A total of 278 patients were randomized in 8 Viennese hospitals. After 12 months, the BM group had the highest proportion of antineurohormonal triple-therapy (difference among all groups). Accordingly, BM reduced days of HF hospitalization (488 days) compared with the hospitalization for the MC (1,254 days) and UC (1,588 days) groups (p < 0.0001; significant differences among all groups). Using Kaplan-Meier analysis, the first HF rehospitalization (28%) was lower in the BM versus MC groups (40%; p = 0.06) and the MC versus UC groups (61%; p = 0.01). Moreover, the combined end point of death or HF rehospitalization was lower in the BM (37%) than in the MC group (50%; p < 0.05) and in the MC than in the UC group (65%; p = 0.04). Death rate was similar between the BM (22%) and MC groups (22%), but was lower compared with the UC group (39%; vs. BM: p < 0.02; vs. MC: p < 0.02).

Conclusions: Compared with MC alone, additional BM improves clinical outcome in patients after HF hospitalization. (BNP Guided Care in Addition to Multidisciplinary Care; NCT00355017)

Key Words: chronic heart failure • multidisciplinary care • nurse • natriuretic peptide

Abbreviations and Acronyms   ACE-I = angiotensin-converting enzyme inhibitor   BM = N-terminal pro–B-type natriuretic peptide-guided, intensive patient management   BNP = B-type natriuretic peptide   CHF = chronic heart failure   HF = heart failure   MC = multidisciplinary care   NP = natriuretic peptide   NT-proBNP = N-terminal pro–B-type natriuretic peptide   UC = usual care

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