NT-proBNP-guided therapy in acute decompensated heart failure

Acute decompensated heart failure (ADHF) is defined as the acute onset of severe heart failure (HF) or acute-on-chronic HF necessitating urgent hospitalization. Despite currently available therapies, the burden of the disease is extremely high with up to 50% of patients readmitted or deceased within 6 months. Much effort has therefore been devoted and is still needed to improve the outcome of ADHF patients. The natriuretic peptide BNP and the inactive N-terminal fragment of its precursor proBNP, NT-proBNP, are released by cardiomyocytes in response to ventricular or atrial wall stretch. They are used for both diagnostic and prognostic purposes in HF patients or those suspected of HF. Previous studies have demonstrated that both absolute NT-proBNP levels at discharge and a relative reduction in NT-proBNP from admission to discharge predict prognosis. The main objectives of this thesis were to obtain insight in the application and prognostic effects of NT-proBNP-guided therapy in ADHF patients. We studied whether the target of treatment should consist of an absolute discharge NT-proBNP value or a relative NT-proBNP reduction during admission. Furthermore, the need for age-adjusted targets in elderly patients and the timing of NT-proBNP measurements was studied. Lastly, we conducted the first prospective randomized study on in-hospital guidance of HF therapy by targeting an NT-proBNP reduction of >30% at discharge with the aim to decrease mortality and HF readmission rates 6 months after discharge. We conclude that guidance of HF therapy to increase the number of patients with an NT-proBNP target of >30% reduction did not improve outcome.