NT-proBNP-guided therapy did not significantly reduce cardiovascular death or heart failure hospitalization compared to standard care, with HR 0.98 and p=0.88 in the GUIDE-IT trial involving chronic HFrEF patients.
Does biomarker-guided therapy integrated with multimodal remote monitoring improve risk stratification and clinical outcomes in patients with heart failure?
Integrating multi-biomarker panels with non-invasive hemodynamic monitoring may offer a more personalized and dynamic approach to heart failure management than single-biomarker-guided therapy, which has yielded inconsistent clinical benefits.
Effect estimate: HR 0.98 in GUIDE-IT (no significant benefit)
p-value: p=0.88 in GUIDE-IT (no significant benefit)
Effective heart failure (HF) management requires timely recognition and treatment of congestion in both inpatient and outpatient settings. As the complexity of HF care increases, there is a growing interest in improved guided therapy strategies, including both biomarker-driven approaches and non-invasive and invasive remote monitoring. While natriuretic peptides remain the cornerstone of biomarker-based prognostication, emerging biomarkers reflecting diverse pathophysiological processes, such as myocardial stress, fibrosis, and inflammation, offer potential for enhanced risk stratification, particularly when used in serial multimarker panels. Despite their prognostic value, biomarkers are not yet routinely employed in guided therapy. Additionally with the increasing availability hemodynamic remote monitoring strategies and devices, we could learn more about pathophysiological processes, multi-biomarker panels and their relation to congestion and risks for progression of HF which can help to further refine biomarker-guided therapy. This review evaluates the potential use of biomarkers in guided therapy for HF and explores the rationale for their integration into multimodal monitoring frameworks aiming for a more personalized and dynamic model of HF care, in which different monitoring approaches can reinforce each other.
Allach et al. (Wed,) conducted a review in Patients with chronic heart failure, including subgroups younger than 75 years (n=686). NT-proBNP-guided therapy vs. Standard clinical care or usual care was evaluated on Composite of cardiovascular death or heart failure hospitalization (varied by trial) (HR 0.98 in GUIDE-IT (no significant benefit), p=0.88 in GUIDE-IT (no significant benefit)). NT-proBNP-guided therapy did not significantly reduce cardiovascular death or heart failure hospitalization compared to standard care, with HR 0.98 and p=0.88 in the GUIDE-IT trial involving chronic HFrEF patients.