Clinical Research
Heart Failure
N-Terminal Pro–B-Type Natriuretic Peptide-Guided Treatment for Chronic Heart Failure: Results From the BATTLESCARRED (NT-proBNP–Assisted Treatment To Lessen Serial Cardiac Readmissions and Death) Trial

https://doi.org/10.1016/j.jacc.2009.02.095Get rights and content
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Objectives

The purpose of this study was to compare the effects of N-terminal pro–B-type natriuretic peptide (NT-proBNP)-guided therapy with those of intensive clinical management and with usual care (UC) on clinical outcomes in chronic symptomatic heart failure.

Background

Initial trial results suggest titration of therapy guided by serial plasma B-type natriuretic peptide levels improves outcomes in patients with chronic heart failure, but the concept has not received widespread acceptance. Accordingly, we conducted a longer-term study comparing the effects of NT-proBNP–guided therapy with those of intensive clinical management and with UC of patients with heart failure.

Methods

Three hundred sixty-four patients admitted to a single hospital with heart failure were randomly allocated 1:1:1 (stratified by age) to therapy guided by NT-proBNP levels or by intensive clinical management, or according to UC. Treatment strategies were applied for 2 years with follow-up to 3 years.

Results

One-year mortality was less in both the hormone- (9.1%) and clinically-guided (9.1%) groups compared with UC (18.9%; p = 0.03). Three-year mortality was selectively reduced in patients ≤75 years of age receiving hormone-guided treatment (15.5%) compared with their peers receiving either clinically managed treatment (30.9%; p = 0.048) or UC (31.3%; p = 0.021).

Conclusions

Intensive management of chronic heart failure improves 1-year mortality compared with UC. Compared with clinically guided treatment and UC, hormone-guided treatment selectively improves longer-term mortality in patients ≤75 years of age. (NT-proBNP–Assisted Treatment To Lessen Serial Cardiac Readmissions and Death [BATTLESCARRED]; Australian New Zealand Clinical Trials Registry 12605000735651)

Key Words

NT-proBNP
chronic heart failure
survival

Abbreviations and Acronyms

ACEI
angiotensin-converting enzyme inhibitor
ARB
angiotensin receptor blocker
BB
beta-adrenergic blocker
BNP
B-type natriuretic peptide
CG
clinically guided
CHF
chronic heart failure
LVEF
left ventricular ejection fraction
NT-proBNP
N-terminal pro–B-type natriuretic peptide
NYHA
New York Heart Association
UC
usual care

Cited by (0)

This trial was supported by grants from the Health Research Council of New Zealand and the National Heart Foundation of New Zealand. Dr. Troughton is a recipient of honoraria from Roche Diagnostics. Dr. Richards is a recipient of honoraria and research grants from Roche Diagnostics.