| Management of chronic heart failure guided by individual N-terminal pro-B-type natriuretic peptide targets: results of the PRIMA (Can PRo-brain-natriuretic peptide guided therapy of chronic heart failure IMprove heart fAilure morbidity and mortality?) study. | |
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MedLine Citation:
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PMID: 21144969 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The purpose of this study was to assess whether management of heart failure (HF) guided by an individualized N-terminal pro-B-type natriuretic peptide (NT-proBNP) target would lead to improved outcome compared with HF management guided by clinical assessment alone. BACKGROUND: Natriuretic peptides may be attractive biomarkers to guide management of heart failure (HF) and help select patients in need of more aggressive therapy. The PRIMA (Can PRo-brain-natriuretic peptide guided therapy of chronic heart failure IMprove heart fAilure morbidity and mortality?) study is, to our knowledge, the first large, prospective randomized study to address whether management of HF guided by an individualized target NT-proBNP level improves outcome. METHODS: A total of 345 patients hospitalized for decompensated, symptomatic HF with elevated NT-proBNP levels at admission were included. After discharge, patients were randomized to either clinically-guided outpatient management (n = 171), or management guided by an individually set NT-proBNP (n = 174) defined by the lowest level at discharge or 2 weeks thereafter. The primary end point was defined as number of days alive outside the hospital after index admission. RESULTS: HF management guided by this individualized NT-proBNP target increased the use of HF medication (p = 0.006), and 64% of HF-related events were preceded by an increase in NT-proBNP. Nevertheless, HF management guided by this individualized NT-proBNP target did not significantly improve the primary end point (685 vs. 664 days, p = 0.49), nor did it significantly improve any of the secondary end points. In the NT-proBNP-guided group mortality was lower, as 46 patients died (26.5%) versus 57 (33.3%) in the clinically-guided group, but this was not statistically significant (p = 0.206). CONCLUSIONS: Serial NT-proBNP measurement and targeting to an individual NT-proBNP value did result in advanced detection of HF-related events and importantly influenced HF-therapy, but failed to provide significant clinical improvement in terms of mortality and morbidity. (Effect of NT-proBNP Guided Treatment of Chronic Heart Failure [PRIMA]; NCT00149422). |
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Authors:
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Luc W M Eurlings; Petra E J van Pol; Wouter E Kok; Sandra van Wijk; Cara Lodewijks-van der Bolt; Aggie H M M Balk; Dirk J A Lok; Harry J G M Crijns; Dave J W van Kraaij; Nicolaas de Jonge; Joan G Meeder; Martin Prins; Yigal M Pinto |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 56 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-12-14 Completed Date: 2011-04-05 Revised Date: 2011-08-11 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 2090-100 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Maastricht University Medical Center, Maastricht, the Netherlands. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00149422 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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administration & dosage* Aged Aged, 80 and over Aldosterone Antagonists / administration & dosage Angiotensin II Type 1 Receptor Blockers / administration & dosage Angiotensin-Converting Enzyme Inhibitors / administration & dosage* Anti-Arrhythmia Agents / administration & dosage Biomarkers, Pharmacological / blood Digoxin / administration & dosage Diuretics / administration & dosage* Female Heart Failure / blood, drug therapy*, mortality Humans Male Middle Aged Natriuretic Peptide, Brain / blood* Peptide Fragments / blood* Prospective Studies |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Aldosterone Antagonists; 0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Anti-Arrhythmia Agents; 0/Biomarkers, Pharmacological; 0/Diuretics; 0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 20830-75-5/Digoxin |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2011 Jun 28;58(1):90; author reply 90-1
[PMID:
21700095
]
J Am Coll Cardiol. 2010 Dec 14;56(25):2101-4 [PMID: 21144970 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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