1. Brain-type natriuretic peptide (BNP) screening and collaborative care reduced the combined rates of LV systolic dysfunction, diastolic dysfunction, and heart failure.
2. The rates of hospitalizations for cardiovascular events were significantly higher in patients not screened for BNP.
Evidence Rating Level: 1 (Excellent)
Study Rundown: While heart failure survival has improved over time, a 5-year mortality rate of nearly 50% suggest much needed new screening methods. This study is the first randomized trial to incorporate BNP levels in managing asymptomatic patients with cardiovascular risk factors, demonstrating a reduction in LV systolic dysfunction and major cardiovascular hospitalizations. Previous research suggests the potential new benefits of using BNP as a predictive factor, as BNP is thought to respond to already established cardiovascular damage and fibroinflammation, the pathophysiologic basis for many cardiovascular diseases. Limitations such as overall low event rates and thus limited generalizability, lack of blinding to the BNP intervention, and not including clinically significant endpoints such as patient reported improvement in symptoms or exercise capacity, call for further research in larger, more heterogeneous populations to more accurately determine mortality and all-cause hospitalization outcome. Overall, with additional research, BNP measurement could represent a method of identifying asymptomatic, at risk patients with increased risk of developing heart failure.
In-Depth [prospective parallel-group randomized trial]: This study included a total of 1374 participants with cardiovascular risk factors (e.g. age>40, hypertension, hypercholesterolemia, and obesity) from 39 primary care practices in Ireland between Jan 2005 and Dec 2009 and followed until Dec 2011. Patients in the control group received lifestyle modification and risk factor intervention without BNP results. Patients in the intervention group with BNP> 50pg/mL underwent echocardiography and received multidimensional specialist interventions. The primary endpoint included asymptomatic LV systolic dysfunction, which occurred in 6.6% of control group versus 4.3% in intervention group (OR, 0.57; 95% CI, 0.370.88; P = .01). Secondary endpoints included emergency hospitalizations for major cardiovascular events for which the incidence rates were 40.4 per 1000 patient-years in the control group versus 22.3 per 1000 patient-years in the intervention group (IRR, 0.60; 95% CI, 0.45-0.81; P = .002).
By Elizabeth Park and Brittany Hasty
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