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.
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.
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%
- Patients with acute decompensated heart failure
- NT-proBNP >1700 ng/L
- 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
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).
- Readmission for heart failure within 180 days: 24% in the NT-proBNP group vs. 26% in the conventional therapy group (p = 0.73)
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.
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].
Keywords: Acute Disease, Biological Markers, Heart Failure, Mortality, Natriuretic Peptide, Brain, Patient Readmission, Peptide Fragments
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