Effects of RhBNP combined with immune modulation on immune function and short-term clinical outcomes in patients with atrial fibrillation and heart failure

Background: Heart failure (HF) and atrial fibrillation (AF) commonly coexist, sharing underlying pathophysiology and risk factors, which leads to high morbidity and complex clinical management. While recombinant human B-type natriuretic peptide (rhBNP) is used for acute HF, its combined effect with traditional Chinese medicine for immune regulation in HF patients with persistent AF remains unclear. Objective: This study aimed to evaluate the efficacy and immunological impact of rhBNP combined with an immunomodulatory therapy in patients with HF and permanent AF. Methods: In this randomized, prospective, controlled trial, 40 hospitalized patients with HF (NYHA class II-III, LVEF ≤40%) and permanent AF were enrolled. Participants were randomly assigned to receive conventional therapy alone (Control group, n = 20) or conventional therapy plus intravenous rhBNP and oral Zhenqi Fuzheng Granules for 7 days (Treatment group, n = 20). Results: Compared to the control group, the treatment group showed significantly greater reductions in BNP levels and greater improvement in left ventricular ejection fraction (LVEF). Immunophenotyping analysis revealed that the treatment group had significantly increased absolute counts of CD3+ and CD4+ T lymphocytes and a higher CD4+/CD8+ ratio. Conclusion: Adjunctive therapy combining rhBNP and immunomodulation in HF-AF patients significantly improves cardiac function, and is associated with improved short-term clinical outcomes. This suggests a promising multi-mechanistic therapeutic approach for this patient population.