TY - JOUR
T1 - Bias in natriuretic peptide-guided heart failure trials: time to improve guideline adherence using alternative approaches
AU - Stienen, Susan
AU - Bhatt, Ankeet
AU - Ferreira, João Pedro
AU - Vaduganathan, Muthiah
AU - Januzzi, James
AU - Adams, Kirkwood
AU - Tardif, Jean-Claude
AU - Rossignol, Patrick
AU - Zannad, Faiez
N1 - Publisher Copyright: © 2020, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Treatment of patients with heart failure with reduced ejection fraction (HFrEF) with currently available therapies reduces morbidity and mortality. However, implementation of these therapies is a problem with only few patients achieving guideline-recommended maximal doses of therapy. In an effort to improve guideline adherence and uptitration, several trials have investigated a biomarker-guided strategy (using natriuretic peptide targets in specific), but although conceptually promising, these trials failed to show a consistent beneficial effect on outcomes. In this review, we discuss different methodological issues that may explain the failure of these trials and offer potential solutions. Moreover, alternative approaches to increase heart failure guideline adherence are evaluated.
AB - Treatment of patients with heart failure with reduced ejection fraction (HFrEF) with currently available therapies reduces morbidity and mortality. However, implementation of these therapies is a problem with only few patients achieving guideline-recommended maximal doses of therapy. In an effort to improve guideline adherence and uptitration, several trials have investigated a biomarker-guided strategy (using natriuretic peptide targets in specific), but although conceptually promising, these trials failed to show a consistent beneficial effect on outcomes. In this review, we discuss different methodological issues that may explain the failure of these trials and offer potential solutions. Moreover, alternative approaches to increase heart failure guideline adherence are evaluated.
KW - Adherence
KW - Bias
KW - Biomarker
KW - Biomarker-guided trials
KW - Guideline-directed
KW - HFrEF
KW - Medical therapy
KW - Natriuretic peptides
UR - http://www.scopus.com/inward/record.url?scp=85089288824&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s10741-020-10004-6
DO - https://doi.org/10.1007/s10741-020-10004-6
M3 - Review article
C2 - 32783110
SN - 1382-4147
VL - 26
SP - 11
EP - 21
JO - Heart Failure Reviews
JF - Heart Failure Reviews
IS - 1
ER -