Assessing the benefits of natriuretic peptides-guided therapy in chronic heart failure.

Heart failure (HF) is a major public heart burden among the ageing population. Optimizing management of patients remains challenging despite many advances in therapy for this pathology. Natriuretic peptides (NPs) are related to cardiac morbidity and mortality and their use in guiding treatment might help. Most data on the value of NPs-guided therapy in chronic HF came from centers with high experience in the therapy of HF. Ninety percent of patients had preserved left ventricular function. The story is just too complex to have the final answer. The numbers of treated patients is insufficient to allow a final decision. Most data derive from centers with high skills and were obtained with different assays, different protocols. Many questions are open. Can similar results be obtained in less specialized centers? It is undecided which NP should be used and how high should be the levels to guide the therapy. Which patients might especially benefit from this approach? Is the approach useful in patients with reduced systolic function? Is the strategy as useful in the elderly as in younger patients? In spite of these limitations, available data suggest that it is reasonable to consider the use of NPs to guide the therapy of HF with preserved systolic function. In order to answer some of the questions, a multicenter, prospective study began in January 2013. However, NP guided therapy in chronic HF will only find acceptance in clinical practice if its use results in therapeutic consequences.