Post-Discharge NT-proBNP Level Monitoring in the Management of Patients With HFpEF
TAKE-HOME MESSAGE
- In this small, multicenter, randomized controlled trial involving 157 individuals hospitalized with HFpEF, a strategy of routine NT-proBNP level monitoring alone after discharge did not reduce the rate of rehospitalization for heart failure. However, in secondary and exploratory analyses, it was associated with greater utilization of medical therapies.
- These data extend prior analyses and suggest that monitoring of NT-proBNP levels may provide additional postdischarge information of relevance for therapeutic decision–making. However, the net clinical benefit of this strategy remains uncertain in all populations and healthcare systems.
abstract
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Access this abstract nowAIMS
There is a lack of specific studies assessing the impact of natriuretic peptide monitoring in the post-discharge management of patients with heart failure (HF) and preserved ejection fraction (HFpEF), throughout the vulnerable phase following acute HF hospitalization. The NICE study aims to assess the clinical benefit of incorporating N-terminal pro-B-type natriuretic peptide (NT-proBNP) into the post-discharge management of HFpEF patients.
METHODS AND RESULTS
Individuals admitted with HFpEF (left ventricular ejection fraction >50%) were included in a multicentre randomized controlled study employing an open-label design with event blinding (NCT02807168). Upon discharge, 157 patients were randomly allocated to either NT-proBNP monitoring (n = 79) or no access to NT-proBNP (control group, n = 78) during pre-scheduled visits at 2, 4 and 12 weeks. Clinical endpoints were evaluated at 6 months. The primary endpoint of HF rehospitalizations occurred in 12.1% patients, without significant differences observed between the NT-proBNP monitoring group (12.8%) and the control group (11.4%) (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.47-2.81, p = 0.760). Regarding secondary endpoints, the NT-proBNP monitoring group demonstrated a significantly lower risk of death (1.3% vs. 10.1%; HR 0.12, 95% CI 0.02-0.09), whereas non-HF hospitalizations (12.8% vs. 19.0%, p = 0.171) and any adverse clinical event (26.9% vs. 36.7%, p = 0.17) did not reach statistical significance. Awareness of NT-proBNP levels were associated with higher doses of diuretics and renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers) in the NT-proBNP monitoring group.
CONCLUSIONS
Post-discharge monitoring of NT-proBNP in HFpEF patients did not exhibit an association with reduced rates of HF hospitalization in this study. Nonetheless, it appears to enhance global clinical management by optimizing medical therapies and contributing to improved overall survival.
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Additional Info
N-terminal pro-B-type natriuretic peptide post-discharge monitoring in the management of patients with heart failure and preserved ejection fraction - a randomized trial: The NICE study
Eur. J. Heart Fail 2024 Apr 12;[EPub Ahead of Print], DA Pascual-Figal, A Hernández-Vicente, F Pastor-Pérez, M Martínez-Sellés, E Solé-González, J Alvarez-García, P García-Pavía, A Varela-Román, PL Sánchez, JF Delgado, JA Noguera-Velasco, A Bayes-GenisFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.