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Natriuretic peptide-guided heart failure management
Richard Troughton1, G Michael Felker, James L Januzzi
1Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
Insights
Natriuretic peptides, like B-type natriuretic peptide (BNP) and NT-proBNP, can guide heart failure (HF) therapy. Optimizing treatment based on these biomarkers and achieving suppression below thresholds improves patient outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Management
Background:
- Natriuretic peptides (NPs), including B-type natriuretic peptide (BNP) and NT-proBNP, are crucial for diagnosing and determining prognosis in heart failure (HF).
- Therapeutic interventions for HF lead to parallel changes in BNP and NT-proBNP levels, reflecting treatment benefits.
Purpose of the Study:
- To explore the concept of using natriuretic peptides as a guide for intensifying heart failure care.
- To assess the impact of optimizing therapy and achieving NP suppression on patient outcomes.
Main Methods:
- Reviewing past studies on biomarker-guided HF therapy.
- Analyzing the dynamic changes in BNP and NT-proBNP in response to HF therapies.
- Evaluating the combination of guideline-directed medical therapy (GDMT) and NP suppression.
Main Results:
- Studies combining therapy optimization and NP suppression below prognostic thresholds show superior outcomes.
- This integrated approach has been observed to be well-tolerated by patients.
- US HF guidelines now recommend natriuretic peptide-guided therapy for achieving GDMT (Class IIa) and potentially improving outcomes (Class IIb).
Conclusions:
- Natriuretic peptide-guided HF therapy represents a novel approach to managing heart failure.
- Further clinical trial data is anticipated to inform international guidelines, such as those from the European Society of Cardiology.
- This strategy holds promise for improving patient outcomes in heart failure management.
Abstract:
The natriuretic peptides are important tools to establish diagnosis and prognosis in heart failure (HF). With application of therapies for HF, changes in both B-type natriuretic peptide (BNP) and its amino terminal cleavage fragment (NT-proBNP) parallel the benefits of the HF therapy applied. This dynamic nature of BNP and NT-proBNP relative to therapeutic intervention in HF has led to the concept of using the biomarkers as a 'guide' for intensification of HF care with a goal of not only achieving guideline-directed medical therapy goals accompanied by targeted natriuretic peptide suppression below prognostic thresholds. In studies achieving this combination of therapy optimization and BNP/NT-proBNP suppression, superior outcomes have been observed, and the approach was well tolerated. Natriuretic peptide-guided HF therapy has recently been given a recommendation in US HF guidelines to achieve guideline-directed medical therapy (Class IIa) and possibly improve outcome (Class IIb), while other clinical practice guidelines (including those from the European Society of Cardiology) await results from emerging clinical trial data. We will review lessons learned in the past regarding this novel concept of biomarker guided HF care, and discuss future directions for the approach.
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