Key result
Early NT-proBNP goal achievement of ≤1000 pg/mL was associated with an 82% reduction in death or heart failure hospitalization in women, compared with a 59% reduction in men.
Why the study?
It is unclear whether sex differences exist in NT-proBNP response and whether the therapeutic target of NT-proBNP <=1000 pg/mL provides equivalent prognostic value in men and women with HFrEF.
Does achieving an early NT-proBNP goal of ≤1000 pg/mL have different prognostic value in men versus women with HFrEF?
Cohort (n=894)
Does achieving an early NT-proBNP goal of ≤1000 pg/mL have different prognostic value in men versus women with HFrEF?
Achieving an early NT-proBNP goal of ≤1000 pg/mL has greater prognostic value for reducing death or HF hospitalization in women with HFrEF compared to men.
Answers are grounded in this paper and cite their sources.
May support sex-specific NT-proBNP targets in HFrEF; hypothesis-generating and requires prospective validation before practice change.
Background NT-proBNP (N-terminal pro-B-type natriuretic peptide) is a prognostic biomarker in heart failure (HF) with reduced ejection fraction. However, it is unclear whether there is a sex difference in NT-proBNP response and whether the therapeutic goal of NT-proBNP ≤1000 pg/mL has equivalent prognostic value in men and women with HF with reduced ejection fraction. Methods and Results In a secondary analysis of the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment) trial we analyzed trends in NT-proBNP and goal attainment by sex. Differences in clinical characteristics, HF treatment, and time to all-cause death or HF hospitalization were compared. Landmark analysis at 3 months determined the prognostic value of early NT-proBNP goal achievement in men and women. Of the 286 (32%) women and 608 (68%) men in the GUIDE-IT trial, women were more likely to have a nonischemic cause and shorter duration of HF. Guideline-directed medical therapy was less intense over time in women. The absolute NT-proBNP values were consistently lower in women; however, the change in NT-proBNP and clinical outcomes were similar. After adjustment, women achieving the NT-proBNP goal had an 82% reduction in death or HF hospitalization compared with a 59% reduction in men. Conclusions Men and women with HF with reduced ejection fraction had a similar NT-proBNP response despite less intensive HF treatment among women. However, compared with men, the early NT-proBNP goal of ≤1000 pg/mL had greater prognostic value in women. Future efforts should be aimed at intensifying guideline-directed medical therapy in women, which may result in greater NT-proBNP reductions and improved outcomes in women with HF with reduced ejection fraction. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01685840.
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Daubert et al. (2021) conducted a cohort in Heart failure with reduced ejection fraction (n=894). Early NT-proBNP goal achievement (≤1000 pg/mL) vs. Non-achievement was evaluated on All-cause death or HF hospitalization. Early NT-proBNP goal achievement of ≤1000 pg/mL was associated with an 82% reduction in death or heart failure hospitalization in women, compared with a 59% reduction in men.
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