Can Natriuretic Peptide Levels Guide Treatment for Heart Failure?

The relationship between natriuretic peptide levels and prognosis in heart failure (HF) is universally accepted, but using these levels to guide treatment remains highly controversial. Although meta-analyses have suggested benefits, the underlying studies are small and heterogeneous in design. The American College of Cardiology/American Heart Association HF guideline (NEJM JW Cardiol Sep 2017 and Circulation 2017; 136:e137) supports the use of these biomarkers for diagnosis and prognosis but not for directing therapy. To learn more, researchers in the GUIDE-IT trial enrolled 894 patients with HF and reduced ejection fraction who had an HF event (e.g., hospitalization) within the last year and an elevated N-terminal pro–B-type natriuretic pe…