a prospective evaluation of natriuretic peptide based referral of chf patients in primary care

Conditions: Chronic Heart Failure (CHF)

Summary: this low interventional study, whose unique intervention was to measure the blood level of a biomarker called nt-probnp in chronic heart failure patients daily followed-up by primary care physicians (pcps) in europe, assessed if the cardiologist referral guided by nt-probnp measurement in patients who were currently judged by pcps as being stable, would lead to optimization of hf treatment, defined in adherence to treatment recommendations of the current european society of cardiology guidelines for the treatment of heart failure.

in the majority of european countries, the primary management of chronic heart failure patients was performed by general practitioners in collaboration with cardiologists (specialists). previous studies had shown that many patients suffering from chf do not receive optimal pharmacological and/or device treatment for their disease. an increase in natriuretic peptides (bnp, nt-probnp) was associated with increased risk of cardiovascular events in heart failure patients. the purpose of the present study was to assess if a referral of clinical stable chronic heart failure patients with reduced ventricular ejection fraction (ef \ or = 600 pg/ml to a specialist (cardiologist) led to treatment optimization, defined as adherence to the treatment recommendations according to the european society of cardiology (esc) guidelines. in addition, data obtained in this study was used to describe demographic, clinical (including nt-probnp levels) and treatment characteristics of chf patients who were managed in the primary care setting across europe..

Eligibility criteria:
inclusion criteria: * willing and able to provide written informed consent and accept study procedures and time schedule. * age ≥ 18 years. * patients suffering from chronic heart failure (the heart failure diagnosis must have been made or confirmed by a cardiologist and/or hospital physician at any time in the patient's medical history). * patients with reduced ejection fraction (≤ 40%) as confirmed at any time point in the patient's medical history. exclusion criteria: * use of investigational drugs either within 5 half-lives of enrollment, or within 30 days, or until the expected pharmacodynamic effect has returned to baseline, whichever is longer. * major surgery in the last 3 months prior to baseline or planned major surgery or cardiac intervention during the study. * cancer or other significant co-morbidities implying that the patient's condition is unstable. * comorbidities that can be associated with elevated natriuretic peptide (np) levels: renal insufficiency, (egfr \< 25 ml/min/1.73 m² calculated according to mdrd formula), recent (less than 3 months) cerebral trauma or recent (less than 3 months) cerebrovascular incident, novel diagnosis or acute exacerbation of copd within the last 3 months. * patients who are primarily managed and regularly followed-up by a cardiologist for their hf * highly frail patients whose estimated lifespan due to comorbidities by the judgement of the investigator is less than 6 months.

Keywords: low-interventional observational study, chf, heart failure, primary care, esc guidelines, europe, nt-probnp, reduced ventricular ejection fraction (ef),