N-terminal Pro Brain Natriuretic Peptide-Guided Management in Patients with Heart Failure and Preserved Ejection Fraction: Findings from the Trial of Intensified Versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME-CHF)
Why the study?
Does NT-proBNP-guided medical management improve 18-month outcomes compared to symptom-guided management in elderly patients with heart failure and preserved ejection fraction?
Population
622 patients aged ≥60 years with heart failure and elevated NT-proBNP, comprising 123 patients with HFpEF…
Comparison
NT-proBNP-guided medical management during a… vs Symptom-guided medical management during a…
Design
RCT, randomized
Follow-up
18 months
Authors
Discussion
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Member takes
Implication
NT-proBNP guidance may harm elderly HFpEF patients; challenges uniform biomarker-directed strategies across LVEF strata.
Structured PICO
Does NT-proBNP-guided medical management improve 18-month outcomes compared to symptom-guided management in elderly patients with heart failure and preserved ejection fraction?
P
Population
622 patients aged ≥60 years with heart failure (NYHA class ≥II) and elevated NT-proBNP (>400 ng/L or >800 ng/L depending on age), comprising 123 patients with HFpEF (LVEF >45%) and 499 patients with HFrEF (LVEF ≤45%).
I
Intervention
NT-proBNP-guided medical management (therapy titrated to reduce symptoms to NYHA ≤II and reduce NT-proBNP below the inclusion threshold) during a 6-month period.
C
Comparator
Symptom-guided medical management (therapy titrated only to reduce symptoms to NYHA ≤II) during a 6-month period.
O
Outcome
Hospitalization-free survival at 18 monthshard clinical
In contrast to patients with HFrEF, NT-proBNP-guided therapy does not appear beneficial and may worsen outcomes in elderly patients with HFpEF.
Cite This Study
Maeder et al. (2013) studied this question.