Can NT-proBNP guided therapy during hospitalization for acute decompensated heart failure reduce mortality and readmissions? - PRIMA II

Contribution To Literature:

The PRIMA II trial failed to show that NT-proBNP-guided therapy was superior to conventional therapy.

Description:

The goal of the trial was to evaluate N-terminal pro–B-type natriuretic peptide (NT-proBNP)-guided therapy compared with conventional therapy among patients with acute decompensated heart failure.

Study Design

  • Randomized
  • Parallel

Patients with acute decompensated heart failure were randomized to NT-proBNP-guided therapy (n = 202) versus conventional therapy (n = 203). In the NT-proBNP-guided therapy group, the goal was to achieve >30% reduction in NT-proBNP levels.

  • Total number of enrollees: 405
  • Duration of follow-up: 180 days
  • Mean patient age: 78 years
  • Percentage female: 53%
  • Percentage with diabetes: 35%

Inclusion criteria:

  • Patients with acute decompensated heart failure
  • NT-proBNP >1700 ng/L

Exclusion criteria:

  • Severe chronic obstructive pulmonary disease
  • Pulmonary embolism in the last month
  • End-stage renal disease
  • Planned percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), cardiac resynchronization therapy (CRT), or valvular surgery
  • History of ST-segment elevation myocardial infarction, PCI, CABG, or CRT in the last month

Principal Findings:

The primary outcome, incidence of mortality or heart failure readmission within 180 days, occurred in 36% of the NT-proBNP-guided therapy group versus 36% of the conventional therapy group (p = 0.99).

Secondary outcomes:

  • Readmission for heart failure within 180 days: 24% in the NT-proBNP group vs. 26% in the conventional therapy group (p = 0.73) 

Interpretation:

Among patients with acute decompensated heart failure, NT-proBNP-guided therapy did not improve clinical outcomes compared with conventional therapy. Based on this study, serial measurements of NT-proBNP levels among patients hospitalized for acute decompensated heart failure are not recommended.

References:

Stienen S, Salah K, Moons AH, et al. NT-proBNP-Guided Therapy in Acute Decompensated Heart Failure: The PRIMA II Randomized Controlled Trial. Circulation 2017;Dec 14:[Epub ahead of print].

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Acute Disease, Biological Markers, Heart Failure, Mortality, Natriuretic Peptide, Brain, Patient Readmission, Peptide Fragments


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