Research reports from University of Basel provide new insights into congestive heart failure
February 23rd, 2009
2009 FEB 23 -- According to recent research published in the Jama - Journal of the American Medical Association, "Context It is uncertain whether intensified heart failure therapy guided by N- terminal brain natriuretic peptide ( BNP) is superior to symptom- guided therapy. To compare 18- month outcomes of N- terminal BNP - guided vs symptomguided heart failure therapy."
"Setting, and Patients Randomized controlled multicenter Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure ( TIMECHF) of 499 patients aged 60 years or older with systolic heart failure ( ejection fraction <= 45%), New York Heart Association ( NYHA) class of II or greater, prior hospitalization for heart failure within 1 year, and N- terminal BNP level of 2 or more times the upper limit of normal. The study had an 18- month follow- up and it was conducted at 15 outpatient centers in Switzerland and Germany between January 2003 and June 2008. Uptitration of guideline- based treatments to reduce symptoms to NYHA class of II or less ( symptom- guided therapy) and BNP level of 2 times or less the upper limit of normal and symptoms to NYHA class of II or less ( BNP- guided therapy). Main Outcome Measures Primary outcomes were 18- month survival free of all- cause hospitalizations and quality of life as assessed by structured validated questionnaires. Heart failure therapy guided by N- terminal BNP and symptom- guided therapy resulted in similar rates of survival free of all- cause hospitalizations ( 41% vs 40%, respectively; hazard ratio [ HR], 0.91 [ 95% CI, 0.72-1.14]; P=. 39). Patients' quality- of-life metrics improved over 18 months of follow- up but these improvements were similar in both the N- terminal BNP - guided and symptom- guided strategies. Compared with the symptom- guided group, survival free of hospitalization for heart failure, a secondary end point, was higher among those in the N- terminal BNP - guided group ( 72% vs 62%, respectively; HR, 0.68 [ 95% CI, 0.50-0.92]; P=. 01). Heart failure therapy guided by N- terminal BNP improved outcomes in patients aged 60 to 75 years but not in those aged 75 years or older ( P<. 02 for interaction)," wrote M. Pfisterer and colleagues, University of Basel.
The researchers concluded: " Heart failure therapy guided by N- terminal BNP did not improve overall clinical outcomes or quality of life compared with symptom- guided treatment. Trial Registration isrctn. org Identifier: ISRCTN43596477."
Pfisterer and colleagues published their study in Jama - Journal of the American Medical Association (BNP-Guided vs Symptom-Guided Heart Failure Therapy The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial. Jama - Journal of the American Medical Association, 2009;301(4):383-392).
For additional information, contact M. Pfisterer, University of Basel Hospital, Dept. of Cardiology, CH-4031 Basel, Switzerland.
The publisher's contact information for the Jama - Journal of the American Medical Association is: American Medical Association, 515 N State St., Chicago, IL 60610-0946, USA.
Keywords: Switzerland, Basel, Cardiology, Clinical Trial Research, Congestive Heart Failure, Coronary Artery Disease, Heart Disease, Therapy, Treatment, University of Basel.
This article was prepared by Biotech Business Week editors from staff and other reports. Copyright 2009, Biotech Business Week via NewsRx.com.
