Boesing Maria, Bierreth Frederick, Abig Kristin, Giezendanner Stéphanie, Leuppi-Taegtmeyer Anne B, Lüthi-Corridori Giorgia, Maier Sabrina, Züsli Stephanie, Leuppi Jörg D, Dieterle Thomas
University Institute of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.
Faculty of Medicine, University of Basel, Basel, Switzerland.
Glob Cardiol Sci Pract. 2024 Aug 1;2024(4):e202431. doi: 10.21542/gcsp.2024.31.
Serial N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements have proven to be useful for therapy monitoring in patients hospitalized for acute decompensated heart failure (ADHF). The POC-HF pilot study investigated whether serial NT-proBNP measurements influenced treatment decisions in these patients.
Patients hospitalized for ADHF were randomly assigned to an intervention group (serial NT-proBNP measurements made available to treating physicians) or a control group (care as usual). HF therapy was administered at the discretion of the treating physician. The primary endpoint was dose changes in HF therapy during hospitalization. Secondary endpoints included changes in NT-proBNP levels, recovery from HF symptoms, length of hospital stay, and quality of life.
52 patients (35% female; mean age 81.8 years) were included. The availability of serial NT-proBNP values was associated with higher dosages of ACE inhibitors (relative treatment effect (RTE) day 11:0.74, = 0.007) and loop diuretics (RTE day 11:0.77, = 0.005), and lower dosages of beta-blockers (RTE day 11:0.43, = 0.002). NT-proBNP levels decreased (-752 pg/ml, = 0.162) and recovery rates from ADHF symptoms were more pronounced in the intervention group, but without statistical significance. No differences were found in terms of the length of hospital stay and quality of life.
The results of this pilot trial indicate that serial NT-proBNP measurements are possibly associated with faster up-titration of HF medication, more pronounced NT-proBNP decrease, and faster recovery from symptoms than symptom-guided therapy in patients hospitalized for ADHF. These preliminary findings require further validation through larger studies.
http://www.swissethics.ch BASEC-ID 2017-01030, registered on 28 December 2017.
连续测量N末端B型利钠肽原（NT-proBNP）已被证明对急性失代偿性心力衰竭（ADHF）住院患者的治疗监测有用。POC-HF试点研究调查了连续测量NT-proBNP是否会影响这些患者的治疗决策。
因ADHF住院的患者被随机分配到干预组（向治疗医生提供连续NT-proBNP测量值）或对照组（常规治疗）。HF治疗由治疗医生自行决定。主要终点是住院期间HF治疗的剂量变化。次要终点包括NT-proBNP水平的变化、HF症状的缓解、住院时间和生活质量。
纳入52例患者（35%为女性；平均年龄81.8岁）。连续NT-proBNP值的可用性与更高剂量的ACE抑制剂（第11天相对治疗效果（RTE）：0.74，P = 0.007）和袢利尿剂（第11天RTE：0.77，P = 0.005）以及更低剂量的β受体阻滞剂（第11天RTE：0.43，P = 0.002）相关。干预组NT-proBNP水平下降（-752 pg/ml，P = 0.162），ADHF症状的缓解率更明显，但无统计学意义。住院时间和生活质量方面未发现差异。
该试点试验的结果表明，对于因ADHF住院的患者，连续测量NT-proBNP可能与HF药物更快上调剂量、NT-proBNP更明显下降以及症状缓解比症状导向治疗更快有关。这些初步发现需要通过更大规模的研究进一步验证。
http://www.swissethics.ch BASEC-ID 2017-01030，于2017年12月28日注册。
