A Heart-Failure Prevention Strategy Put to the Test

The prevalence of heart failure (HF) is rising, despite progress in understanding and treating risk factors. In a nonblinded trial, 1374 adults (average age, 65; 45% men) with ≥1 risk factor for HF (≥3, 27%) underwent annual B-type natriuretic peptide (BNP) screening and were randomized to either BNP-guided intervention or usual care, in which BNP results were unavailable to providers. Intervention-group participants with elevated BNP levels (≥50 pg/mL) were referred for echocardiography and collaborative specialist–primary care. The primary endpoint was the composite of new-onset HF and left ventricular (LV) systolic dysfunction, with or without symptoms; because of slower-than-anticipated enrollment, LV diastolic dysfunction was added to the composite endpoint after trial inception.

During mean follow-up of 4.2 years, the revised primary endpoint occurred significantly less frequently in the intervention group than in the usual-care group (5.3% vs. 8.7%; odds ratio, 0.55). The rate of asymptomatic LV dysfunction was also lower in the intervention group (4.3% vs. 6.6%; OR, 0.57; P=0.01). The risk for symptomatic HF did not differ significantly between the two groups (1.0% vs. 2.1%; OR, 0.48; P=0.12), but the risk for emergency cardiovascular hospitalization was significantly lower in the intervention group (22.3 vs. 40.4 per 1000 patient-years). Of note, renin-angiotensin-aldosterone–inhibitor use was more common in the intervention group than in the usual-care group (56.5% vs. 49.6%).