Natriuretic Peptide-Guided Therapy No Better Than Usual Care in Heart Failure Patients

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH

In high-risk patients with heart failure, using natriuretic peptide levels to guide medical therapy is no better than optimal medical therapy alone, a JAMA study finds.

Nearly 900 adults with chronic heart failure and reduced ejection fraction, plus recently elevated amino-terminal pro–B-type natriuretic peptide (NT-proBNP) levels, were randomized to receive either NT-proBNP-guided therapy or optimal medical therapy alone (controls). In the intervention group, medical therapy was titrated to achieve NT-proBNP levels below 1000 pg/mL.

During roughly 15 months' follow-up, the primary outcome — a composite of heart failure hospitalization or cardiovascular death — was similar between groups (37%). Accordingly, the trial was stopped early owing to the intervention's futility.

Dr. Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, comments: "For years, many have flocked to this test as a way to monitor — now BNP joins many other tests/monitoring methods that have added cost without benefit. Should we start treating testing/monitoring like drugs, insisting on evidence of benefit before widespread adoption?"