Page 55 - Biomarkers for risk stratification and guidance in heart failure
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                                Chapter 3
Management guided by an individualized NT-proBNP target did not significantly improve the primary end point, the number of days alive outside the hospital: median number of days alive outside the hospital was 685 versus 664 days, p=0.49 (Fig. 2). In the NT-proBNP-guided group, mortality was lower, as 46 patients died (26.5%), versus 57 (33.3%) in the clinically-guided group (Fig. 3), but this was not statistically significant. The number of scheduled visits did not differ between the NT-proBNP-guided and the clinically- guided group (mean 7.1±3.1 vs. 6.9±3.0, p=0.424). However, there was a trend towards an increase in unscheduled visits in the NT-proBNP-guided group (mean 1.4±1.9 vs. 1.1±1.7, p=0.063). The total number of cardiovascular and HF-related admissions between the NT-proBNP-guided and the clinically-guided groups were not different (mean 1.11±2.20 vs. 1.05±1.47, p=0.552, and 0.70±1.89 vs. 0.60±1.25, p=0.989). In addition, none of the other prespecified end points was statistically significantly different between the groups (Table 2).
In the subset of patients with left ventricular systolic dysfunction (ejection fraction below 45%), total mortality tended to be lower in the NT-proBNP-guided group, which however did not reach statistical significance (mortality: 25% in NT-proBNP-guided vs. 33% in usual care, p=0.164). In contrast, in patients with preserved left ventricular systolic function, mortality was identical in both groups (31%).
Furthermore, in patients under 75 years of age, a trend was seen towards improved outcome in the NT-proBNP-guided treatment arm (number of days alive outside hospital as percentage of total follow-up: 87.4% vs. 82.8%, p=0.114). Therapy guided by NT-proBNP levels also tended to be favorable in patients with lower discharge creatinine levels, but again these differences did not reach statistical significance (number of days alive outside hospital as percentage of total follow-up: 92.7% vs. 87.9%, p=0.076).
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