Prognostic value of NT-proBNP added to clinical parameters to predict two-year prognosis of chronic heart failure patients with mid-range and reduced ejection fraction – A report from FAR NHL prospective registry

Špinar, Jindřich; Špinarová, Lenka; Málek, Filip; Ludka, Ondřej; Krejčí, Jan; Ošťádal, Petr; Vondráková, Dagmar; Lábr, Karel; Špinarová, Monika; Goldbergová, Monika Pávková; Benešová, Klára; Jarkovský, Jiří; Pařenica, Jiří

doi:10.1371/journal.pone.0214363

Cited by 27 publications

(40 citation statements)

References 28 publications

(36 reference statements)

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“…42.9% of HF patients with CAD and 29.5% with idiopathic dilated cardiomyopathy in the ESC-HF Long-Term Registry; 50.1% of HF patients with CAD and 41.6% with idiopathic dilated cardiomyopathy in the Czech FAR-NHL Registry) (ref. 4,20 ). When compared to the data from the large registries, the difference in the number of cardiomyopathy diagnoses is striking.…”

Section: Discussionmentioning

confidence: 95%

“…The external validity of outcome of patients in specific HF registries is limited because of selectivity of individual hospitals and/or patients' participation. When compared to the FAR-NHL registry of Czech chronic HF patients with 93.8% of chronic HF patients on BBs, there is an evident under-treatment when compared to a sought-after standard of care 4 . The explanation of this under-treatment compared with the registries could be the fact that patients in the analyzed population are added successively.…”

Section: Discussionmentioning

confidence: 99%

“…When a Treated for HF analysis was used and all types of BBs were included, the percentage of BBs use was far more comparable with the HF registries (81.8% of patients in 2012; 81.4% in 2018 vs 93.8% in the FAR-NHL registry) (ref. 4 ). Moreover, data from FAR-NHL registry represent patients treated in a specialized CV center but the majority of patients are treated in out-patient departments.…”

Section: Discussionmentioning

confidence: 99%

“…AF was thus also far more prevalent when compared to the ESC-HF Long-Term Registry (21.5% of HF patients) and FAR-NHL registry (34.8% of HF patients) (ref. 4,20 ). However, the fact that almost a half of the patients had a history of AF does not mean that they were in AF all the time.…”

Section: Discussionmentioning

confidence: 99%

“…If this evidence translates to BBs utilization in common clinical practice is not known. Considering utilization of BBs in HF patients, we have data from several HF registries in the Czech Republic but no registry evaluated all HF patients in the whole country 4,5 . It is unknown if observations from within-registry analyses can be extrapolated to non-enrolled patients.…”

Section: Introductionmentioning

confidence: 99%

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Beta-blockers utilization in heart failure patients: Sub-analysis of a nation-wide population-based study in the Czech Republic

Táborský¹,

Aiglová²,

Lazarová³

et al. 2021

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Beta-blockers utilization in heart failure patients: Sub-analysis of a nation-wide population-based study in the Czech Republic

Táborský¹,

Aiglová²,

Lazarová³

et al. 2021

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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NT‐proBNP Qualifies as a Surrogate for Clinical End Points in Heart Failure

Schmitt

Rühs

Burghaus

et al. 2021

Clin Pharma and Therapeutics

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N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a well-established biomarker in heart failure (HF) but controversially discussed as a potential surrogate marker in HF trials. We analyzed the NT-proBNP/mortality relationship in real-world data (RWD) of 108,330 HF patients from the IBM Watson Health Explorys database and compared it with the NT-proBNP / clinical event end-point relationship in 20 clinical HF studies. With a hierarchical statistical model, we quantified the functional relationship and interstudy variability. To independently qualify the model, we predicted outcome hazard ratios in five phase III HF studies solely based on NT-proBNP measured early in the respective study. In RWD and clinical studies, the relationship between NT-proBNP and clinical outcome is well described by an E max model. The NT-proBNP independent baseline risk (R 0 , RWD/studies median (interstudy interquartile range): 5.5%/3.0% (1.7-4.9%)) is very low compared with the potential NT-proBNP-associated maximum risk (R max : 55.2%/79.4% (61.5-89.0%)). The NT-proBNP concentration associated with the half-maximal risk is comparable in RWD and across clinical studies (EC 50 : 3,880/2,414 pg/mL (1,460-4,355 pg/mL)). Modelbased predictions of phase III outcomes, relying on short-term NT-proBNP data only, match final trial results with comparable confidence intervals. Our analysis qualifies NT-proBNP as a surrogate for clinical outcome in HF trials. NT-proBNP levels after short treatment durations of less than 10 weeks quantitatively predict hazard ratios with confidence levels comparable to final trial readout. Early NT-proBNP measurement can therefore enable shorter and smaller but still reliable HF trials. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an established diagnostic biomarker for the presence of heart failure 1,2 (HF) reflected in diagnostic algorithms of current HF guidelines. 3,4 Over the past decades, a large number of publications investigated the prognostic properties of NT-proBNP for mortality and various cardiovascular events in patients with HF 5 and other cardiovascular (CV) diseases as well as in general elderly populations. 2,6 The association of NT-proBNP elevation with the future occurrence of CV events was shown in several studies. Van Veldhuizen 7 demonstrated

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Prediction of chronic heart failure and chronic obstructive pulmonary disease in a general population: the Tromsø study

et al. 2020

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Aims Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are main causes of dyspnoea, and echocardiography and spirometry are essential investigations for these diagnoses. Our aim was to determine the prevalence of HF and COPD in a general population, also how the diseases may be identified, and to what extent their clinical characteristics differ. Methods and results In the seventh survey of Tromsø study (2015-16), subjects aged 40 years or more were examined with echocardiography, spirometry, lung sound recordings, questionnaires, including the modified Medical Research Council (mMRC) questionnaire on dyspnoea, and N-terminal pro-brain natriuretic peptide analysis. A diagnosis of HF (HF with reduced ejection fraction, HF with mid-range ejection fraction, or HF with preserved ejection fraction) or COPD was established according to current guidelines. Predictors of HF and COPD were evaluated by logistic regression and receiver operating characteristic curve analysis. A total of 7110 participants could be evaluated for COPD, 1624 for HF, and 1538 for both diseases. Age-standardized prevalence of HF was 6.8% for women and 6.1% for men; the respective figures for COPD were 5.2% and 5.1%. Among the 1538 evaluated for both diseases, 139 subjects fulfilled the HF criteria, but only 17.1% reported to have the disease. Of those fulfilling the COPD criteria, 31.6% reported to have the disease. Shortness of breath at exertion was a frequent finding in HF; 59% of those with mMRC ≥2 had HF, while such shortness of breath was found in 24% among those with COPD. Reporting mMRC ≥2 had an odds ratio for HF of 19.5 (95% confidence interval 11.3-33.7), whereas the odds ratio for COPD was 6.3 (95% confidence interval 3.5-11.6). Current smoking was the strongest predictor of COPD but did not predict HF. Basal inspiratory crackles were significant predictors of HF in multivariable analysis. Among the subtypes of HF, an age <70 years was most frequently found in HF with reduced ejection fraction, in 51.7%. Clinical scores based on the predictive value in multivariable analysis of history, symptoms, and signs predicted HF and COPD with areas under the curve of 0.833 and 0.829, respectively. Conclusions Study participants with HF and COPD were in most cases not aware of their condition. In general practice, when an elderly patient present with shortness of breath, both diseases should be considered. Previous cardiovascular disease points at HF, while a history of smoking points at COPD. The threshold should be low for ordering echocardiography or spirometry for verifying the suspected cause of dyspnoea.

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Prognostic value of NT-proBNP added to clinical parameters to predict two-year prognosis of chronic heart failure patients with mid-range and reduced ejection fraction – A report from FAR NHL prospective registry

Cited by 27 publications

References 28 publications

Beta-blockers utilization in heart failure patients: Sub-analysis of a nation-wide population-based study in the Czech Republic

Beta-blockers utilization in heart failure patients: Sub-analysis of a nation-wide population-based study in the Czech Republic

NT‐proBNP Qualifies as a Surrogate for Clinical End Points in Heart Failure

Prediction of chronic heart failure and chronic obstructive pulmonary disease in a general population: the Tromsø study

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