Heart Failure Unit, St. Vincent's University Hospital and University College Dublin, Dublin, Ireland.
Department of Medicine, University of Otago, Christchurch, New Zealand.
Eur J Heart Fail. 2018 Mar;20(3):474-480. doi: 10.1002/ejhf.1053. Epub 2018 Jan 4.
Serial measurement of natriuretic peptides may guide management in heart failure (HF) patients. In previous trials, natriuretic peptides were infrequently monitored, which may undervalue the benefit of this approach.
HOME was an adaptive three-arm randomized clinical study to test whether home monitoring of BNP could reduce HF-related death, hospitalization due to acute decompensated HF (ADHF), and ADHF treated with intravenous diuretics in the emergency department or outpatient setting. Enrolment was terminated early because of slow enrolment, low event rates, and the belief that an algorithm for assessing BNP trends was needed. Justification for pooling data from all study arms was made and analysis as a single observational study was performed. The analysis resulted in 107 patients who were monitored for a median of 172 days with BNP measures on a median of 74% of days. BNP values were highly variable within a patient. Dispersion between serial BNPs was calculated to be 39.3%, 57.7%, and 73.6% for 1, 60, and 120 days between measures, respectively. A moving average filter (fBNP) was calculated to reduce day-to-day fluctuations and track changes from week to week. There were 27 primary events in 17 362 patient days of monitoring; the hazard ratio for time-varying fBNP was 2.22 (95% confidence interval 1.48-3.34) per unit natural log (corresponding to a 2.72-fold change in fBNP level).
The HOME HF study demonstrates the feasibility of home BNP measurement and shows the potential value of fBNP as an index of emerging clinical deterioration. Assessment of the clinical value of this is required.
连续测量利钠肽可指导心力衰竭（HF）患者的治疗。既往研究中，利钠肽监测频率较低，可能低估了该方法的益处。
HOME 是一项适应性三臂随机临床试验，旨在检验家庭监测 BNP 是否能降低 HF 相关死亡率、因急性失代偿性 HF（ADHF）住院以及在急诊科或门诊静脉使用利尿剂治疗 ADHF 的发生率。由于入组缓慢、事件发生率低以及需要评估 BNP 趋势的算法，该研究提前终止。对所有研究臂的数据进行了汇总分析，并进行了单观测研究分析。该分析纳入了 107 例患者，中位随访 172 天，中位 BNP 测量次数为 74%。患者的 BNP 值个体内差异较大。计算两次 BNP 测量值之间的离散度，1、60 和 120 天的离散度分别为 39.3%、57.7%和 73.6%。为减少日内波动，跟踪周间变化，计算了移动平均值（fBNP）。在 17362 患者日的监测中，共有 27 例主要事件；时间变化的 fBNP 的风险比为 2.22（95%置信区间 1.48-3.34）/单位自然对数（对应 fBNP 水平的 2.72 倍变化）。
HOME HF 研究证明了家庭 BNP 测量的可行性，并表明 fBNP 作为临床恶化指标的潜在价值。需要评估该方法的临床价值。
