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Protein Monitoring Improved Heart Failure Treatment

French trial found fewer deaths and hospital stays

WEDNESDAY, April 18, 2007 (HealthDay News) -- A trial that used blood levels of a biomarker called brain natriuretic peptide (BNP) to guide treatment of heart failure more than halved the incidence of death or hospitalization for the condition over 15 months, French cardiologists report.

Just 24 percent of the 110 trial participants whose drug treatment was adjusted according to BNP levels reached those critical end points of death or hospitalization. That compared to 52 percent of those who did not get BNP monitoring.

There were seven deaths from heart failure in the BNP-monitored group, compared to 11 in the non-monitored patients. The overall incidence of hospitalization was about the same in both groups, but just 22 hospital stays due to heart failure complications in the monitored group compared to 48 among patients whose BNP levels were not monitored.

The major difference in medical treatment was use of higher doses of beta-blocker and ACE inhibitor drugs in the BNP-monitored group, the researchers said.

BNP is a protein produced by the muscle cells of the heart ventricles as a response to excess stretching of those cells. Tests of BNP blood levels are used to help diagnosis heart failure, a condition in which the heart progressively loses its ability to pump blood, and to assess the prognosis for people with heart failure. Most drugs used to treat heart failure lower BNP levels.

The study participants, whose average age was 65, had essentially similar symptoms at the start of the trial, although those in the BNP-monitored group had a slightly lower average ejection fraction, which measures the heart's blood-pumping ability.

The findings are published in the April 24 issue of the Journal of the American College of Cardiology.

"This is an important study, because it provides additional information about the role that BNP measurement can play in helping physicians adjust treatment for heart failure," said Dr. Gregg C. Fonarow, co-director of the University of California, Los Angeles, Preventive Cardiology Program. "Many medications can be used to treat heart failure, and guiding those medications can be an art. This trial shows that, beyond standard care, BNP monitoring allows better adjustment of medications," Fonarow said.

Dr. Marvin A. Konstam, chief of cardiology at Tufts-New England Medical Center in Boston, agreed. "This is helpful information. It begins to build a case that monitoring BNP can facilitate medication adjustment for better outcome."

But it was a relatively small study, both Konstam and Fonarow said, and the final word is yet to come. "Additional trials involving more centers will be needed to confirm these findings," Fonarow said. "This is helpful additional information, but we need those additional trials before we can routinely recommend BNP monitoring."

At least two such trials are now under way, Konstam said, with results expected before long.

Konstam had one word of caution about the French results. The trial was not "blinded," meaning the doctors knew which patients were being monitored for BNP levels, and that knowledge might have affected their mode of treatment, he said. "It is a significant possibility and one that has to be clarified," he said.

More information

Heart failure and its treatment are described by the American Heart Association.

SOURCES: Gregg C. Fonarow, M.D., co-director, University of California, Los Angeles, Preventive Cardiology Program; Marvin A. Konstam, M.D., chief, cardiology, Tufts-New England Medical Center, Boston; April 24, 2007, Journal of the American College of Cardiology
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