N-Terminal Pro–B-Type Natriuretic Peptide–Guided Therapy in Chronic Heart Failure Reduces Repeated Hospitalizations—Results From TIME-CHF

Davarzani, Nasser; Wijk, Sandra Sanders‐van; Karel, Joël; Maeder, Micha T.; Leibundgut, Gregor; Gutmann, Marc; Pfisterer, Matthias; Rickenbacher, Peter; Peeters, Ralf; Rocca, Hans‐Peter Brunner‐La

doi:10.1016/j.cardfail.2017.02.001

Cited by 16 publications

(12 citation statements)

References 33 publications

(39 reference statements)

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“…Six studies (Felker 2014; Jourdain 2014; Metra 2012; Moe 2007; Saraya 2015; Steinen 2014) are classified as ongoing. Of these, four studies (Felker 2014; Jourdain 2014; Moe 2007; Steinen 2014) are currently recruiting or have just finished recruiting.…”

Section: Resultsmentioning

confidence: 99%

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B-type natriuretic peptide-guided treatment for heart failure

McLellan

Heneghan

Perera

et al. 2016

Cochrane Database of Systematic Reviews

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Background Heart failure is a condition in which the heart does not pump enough blood to meet all the needs of the body. Symptoms of heart failure include breathlessness, fatigue and fluid retention. Outcomes for patients with heart failure are highly variable; however on average, these patients have a poor prognosis. Prognosis can be improved with early diagnosis and appropriate use of medical treatment, use of devices and transplantation. Patients with heart failure are high users of healthcare resources, not only due to drug and device treatments, but due to high costs of hospitalisation care. B‐type natriuretic peptide levels are already used as biomarkers for diagnosis and prognosis of heart failure, but could offer to clinicians a possible tool to guide drug treatment. This could optimise drug management in heart failure patients whilst allaying concerns over potential side effects due to drug intolerance. Objectives To assess whether treatment guided by serial BNP or NT‐proBNP (collectively referred to as NP) monitoring improves outcomes compared with treatment guided by clinical assessment alone. Search methods Searches were conducted up to 15 March 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (OVID), Embase (OVID), the Database of Abstracts of Reviews of Effects (DARE) and the NHS Economic Evaluation Database in the Cochrane Library. Searches were also conducted in the Science Citation Index Expanded, the Conference Proceedings Citation Index on Web of Science (Thomson Reuters), World Health Organization International Clinical Trials Registry and ClinicalTrials.gov. We applied no date or language restrictions. Selection criteria We included randomised controlled trials of NP‐guided treatment of heart failure versus treatment guided by clinical assessment alone with no restriction on follow‐up. Adults treated for heart failure, in both in‐hospital and out‐of‐hospital settings, and trials reporting a clinical outcome were included. Data collection and analysis Two review authors independently selected studies for inclusion, extracted data and evaluated risk of bias. Risk ratios (RR) were calculated for dichotomous data, and pooled mean differences (MD) (with 95% confidence intervals (CI)) were calculated for continuous data. We contacted trial authors to obtain missing data. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, we assessed the quality of the evidence and GRADE profiler (GRADEPRO) was used to import data from Review Manager to create a 'Summary of findings' table. Main results We included 18 randomised controlled trials with 3660 participants (range of mean age: 57 to 80 years) comparing NP‐guided treatment with clinical assessment alone. The evidence for all‐cause mortality using NP‐guided treatment showed uncertainty (RR 0.87, 95% CI 0...

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Section: Resultsmentioning

confidence: 99%

“…Of these, four studies (Felker 2014; Jourdain 2014; Moe 2007; Steinen 2014) are currently recruiting or have just finished recruiting. Metra 2012 finished recruiting in August 2009 and is due to publish shortly.…”

Section: Resultsmentioning

confidence: 99%

B-type natriuretic peptide-guided treatment for heart failure

McLellan

Heneghan

Perera

et al. 2016

Cochrane Database of Systematic Reviews

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“…An exploratory, post-hoc analysis of the neutral TIME-CHF trial used the gap-time method to compare NT-proBNP-guided therapy with usual care to account for recurrent events 56 . While NT-proBNP-guided therapy was associated with reduced second all-cause hospitalizations, there was no effect on the second heart failure hospitalization.…”

Section: Biomarker-guided Heart Failure Therapymentioning

confidence: 99%

Recent advances in the treatment of chronic heart failure

Buckley¹,

Shah²

2019

F1000Res

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After more than a decade of relatively modest advancements, heart failure therapeutic development has accelerated, with the PARADIGM-HF trial and the SHIFT trial demonstrated significant reductions in cardiovascular death and heart failure hospitalization for sacubitril-valsartan and in heart failure hospitalization alone for ivabradine. Several heart failure therapies have since received or stand on the verge of market approval and promise substantive advances in the treatment of chronic heart failure. Some of these improve clinical outcomes, whereas others improve functional or patient-reported outcomes. In light of these rapid advances in the care of adults living with chronic heart failure, in this review we seek to update the general practitioner on novel heart failure therapies. Specifically, we will review recent data on the implementation of sacubitril-valsartan, treatment of functional mitral regurgitation, sodium-glucose co-transporter-2 (SGLT-2) inhibitor therapy, agents for transthyretin amyloid cardiomyopathy, treatment of iron deficiency in heart failure, and the use of biomarkers or remote hemodynamic monitoring to guide heart failure therapy.

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“…The N-terminal pro-B natriuretic peptide (NT-proBNP) has diagnostic, therapeutic, prognostic, and predictive implications in HF [20,21,22,23]. Natriuretic peptides have found their way into the basic diagnostic approach of HF [13], though NT-proBNP guided treatment has shown only limited success [24,25,26,27]. Soluble suppression of tumorigenesis-2 (sST2) is a new promising biomarker, higher levels are associated with increased myocardial fibrosis and adverse cardiac remodeling [28].…”

Section: Introductionmentioning

confidence: 99%

Use of Cardiac Biomarkers for Monitoring Improvement of Left Ventricular Function by Immunoadsorption Treatment in Dilated Cardiomyopathy

et al. 2019

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Immunoadsorption and subsequent administration of intravenous immunoglobulin (IVIG) have shown beneficial effects on cardiac function and symptoms in patients with dilated cardiomyopathy. Biomarkers play an emerging role in disease monitoring and outcome prediction of heart failure (HF) patients. We aimed to analyze cardiac biomarkers as predictor for improvement of left ventricular (LV) function after immunoadsorption treatment in dilated cardiomyopathy (DCM). Thirty-one patients with dilated cardiomyopathy on optimized HF pharmacotherapy received a single cycle of immunoadsorption for five days followed by IVIG administration. Left ventricular ejection fraction (LVEF) and heart failure biomarkers (hs troponin T, hs troponin I, NT-proBNP and sST2) were evaluated before treatment, after the last cycle of immunoadsorption and during a median follow-up of 30.5 months. We correlated HF biomarkers before immunoadsorption and acute changes of HF biomarkers by immunoadsorption with LV improvement during the long-term follow-up. LV function improved significantly after immunoadsorption from 28.0 to 42.0% during the long-term follow-up (p < 0.0001). Evaluation of biomarker levels showed a significant decrease for hs troponin I (from 9.2 to 5.5 ng/L, p < 0.05) and NT-proBNP (from 789.6 to 281.2 pg/mL, p < 0.005). Correlation of biomarker levels before immunoadsorption and LVEF at the long-term follow-up show good results for hs troponin T (r = −0.40, r2 = 0.16, p < 0.05), hs troponin I (r = −0.41, r2 = 0.17, p < 0.05) and sST2 (r = −0.46, r2 = 0.19, p < 0.05). Correlation of biomarker levels before immunoadsorption and the individual increase in LV function was significant for hs troponin T (r = −0.52, r2 = 0.27, p < 0.005) and hs troponin I (r = −0.53, r2 = 0.29, p < 0.005). To imply a tool for monitoring outcome immediately after immunoadsorption treatment, we investigated the correlation of acute changes of biomarker levels by immunoadsorption treatment and individual increase in LV function. A drop in hs troponin T (r = −0.41, r2 = 0.17, p < 0.05) and hs troponin I (r = −0.53, r2 = 0.28, p < 0.005) levels demonstrate a good correlation to improvement in LVEF during the long-term follow-up. Conclusion: Hs troponin T and I levels correlate with LV function improvement during long-term follow-up. Acute decrease of troponins by immunoadsorption treatment is paralleled by individual improvement of LVEF at the long-term follow-up. Thus, troponins could serve as a monitoring tool for the improvement of LV function after immunoadsorption treatment in dilated cardiomyopathy.

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N-Terminal Pro–B-Type Natriuretic Peptide–Guided Therapy in Chronic Heart Failure Reduces Repeated Hospitalizations—Results From TIME-CHF

Abstract: isrctn.org, identifier: ISRCTN43596477.

Cited by 16 publications

References 33 publications

B-type natriuretic peptide-guided treatment for heart failure

B-type natriuretic peptide-guided treatment for heart failure

Recent advances in the treatment of chronic heart failure

Use of Cardiac Biomarkers for Monitoring Improvement of Left Ventricular Function by Immunoadsorption Treatment in Dilated Cardiomyopathy

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