Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients

Anca Simioniuc, Erberto Carluccio, Stefano Ghio, A. Rossi, Paolo Biagioli, Gianpaolo Reboldi, Gian Giacomo Galeotti, Fei Lu, Cornelia Zara, Gillian A. Whalley, Pierluigi Temporelli, Frank L. Dini

Research output: Contribution to journalArticle

Abstract

Background B-type natriuretic peptide (BNP) and echocardiography are potentially useful adjunct to guide management of patients with chronic heart failure (HF).Thus, the aim of this retrospective, multicenter study was to compare outcomes and renal function in outpatients with chronic HF with reduced ejection fraction (HFrEF) who underwent an echo and BNP guided or a clinically driven protocol for follow-up. Methods and results In 1137 consecutive outpatients, management was guided according to echo-Doppler signs of elevated left ventricular filling pressure and BNP levels conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group in 570 (mean EF = 30%), while management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department in 567 (mean EF = 33%). Propensity score, matching several confounding baseline variables, was used to match pairs based on treatment strategy. The median follow-up was 37.4 months. After propensity matching, a lower incidence of death (HR 0.45, 95%CI: 0.30–0.67, p < 0.0001), and death or worsening renal function (HR 0.49, 95%CI 0.36–0.67, p < 0.0001) was apparent in echo-BNP-guided group compared to clinically-guided group. Worsening of renal function (≥ 0.3 mg/dl increase in serum creatinine) was observed in 9.8% of echo-BNP-guided group and in 21.4% of clinical assessed group (p < 0.0001). The daily dose of loop diuretics did not change in echo-BNP-guided group, while it increased in 65% of patients in clinically-guided group (p < 0.0001). Conclusions Echo and BNP guided management may improve the outcome and reduce worsening of renal function in outpatients with chronic HFrEF.

Original languageEnglish
Pages (from-to)416-423
Number of pages8
JournalInternational Journal of Cardiology
Volume224
DOIs
Publication statusPublished - Dec 1 2016

Fingerprint

Systolic Heart Failure
Natriuretic Peptides
Brain Natriuretic Peptide
Observational Studies
Outpatients
Kidney
Heart Failure
Therapeutics
Sodium Potassium Chloride Symporter Inhibitors
Propensity Score
Confounding Factors (Epidemiology)
Ventricular Pressure
Multicenter Studies
Echocardiography
Creatinine
Thorax
Retrospective Studies
Incidence
Serum

Keywords

  • Echocardiography
  • Heart failure
  • Loop diuretics
  • Natriuretic peptides
  • Outcomes
  • Renal function

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure : An observational study of 1137 outpatients. / Simioniuc, Anca; Carluccio, Erberto; Ghio, Stefano; Rossi, A.; Biagioli, Paolo; Reboldi, Gianpaolo; Galeotti, Gian Giacomo; Lu, Fei; Zara, Cornelia; Whalley, Gillian A.; Temporelli, Pierluigi; Dini, Frank L.

In: International Journal of Cardiology, Vol. 224, 01.12.2016, p. 416-423.

Research output: Contribution to journalArticle

Simioniuc, Anca ; Carluccio, Erberto ; Ghio, Stefano ; Rossi, A. ; Biagioli, Paolo ; Reboldi, Gianpaolo ; Galeotti, Gian Giacomo ; Lu, Fei ; Zara, Cornelia ; Whalley, Gillian A. ; Temporelli, Pierluigi ; Dini, Frank L. / Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure : An observational study of 1137 outpatients. In: International Journal of Cardiology. 2016 ; Vol. 224. pp. 416-423.
@article{2f3568e5e5814c81b8057b8ca026d001,
title = "Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients",
abstract = "Background B-type natriuretic peptide (BNP) and echocardiography are potentially useful adjunct to guide management of patients with chronic heart failure (HF).Thus, the aim of this retrospective, multicenter study was to compare outcomes and renal function in outpatients with chronic HF with reduced ejection fraction (HFrEF) who underwent an echo and BNP guided or a clinically driven protocol for follow-up. Methods and results In 1137 consecutive outpatients, management was guided according to echo-Doppler signs of elevated left ventricular filling pressure and BNP levels conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group in 570 (mean EF = 30{\%}), while management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department in 567 (mean EF = 33{\%}). Propensity score, matching several confounding baseline variables, was used to match pairs based on treatment strategy. The median follow-up was 37.4 months. After propensity matching, a lower incidence of death (HR 0.45, 95{\%}CI: 0.30–0.67, p < 0.0001), and death or worsening renal function (HR 0.49, 95{\%}CI 0.36–0.67, p < 0.0001) was apparent in echo-BNP-guided group compared to clinically-guided group. Worsening of renal function (≥ 0.3 mg/dl increase in serum creatinine) was observed in 9.8{\%} of echo-BNP-guided group and in 21.4{\%} of clinical assessed group (p < 0.0001). The daily dose of loop diuretics did not change in echo-BNP-guided group, while it increased in 65{\%} of patients in clinically-guided group (p < 0.0001). Conclusions Echo and BNP guided management may improve the outcome and reduce worsening of renal function in outpatients with chronic HFrEF.",
keywords = "Echocardiography, Heart failure, Loop diuretics, Natriuretic peptides, Outcomes, Renal function",
author = "Anca Simioniuc and Erberto Carluccio and Stefano Ghio and A. Rossi and Paolo Biagioli and Gianpaolo Reboldi and Galeotti, {Gian Giacomo} and Fei Lu and Cornelia Zara and Whalley, {Gillian A.} and Pierluigi Temporelli and Dini, {Frank L.}",
year = "2016",
month = "12",
day = "1",
doi = "10.1016/j.ijcard.2016.09.034",
language = "English",
volume = "224",
pages = "416--423",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure

T2 - An observational study of 1137 outpatients

AU - Simioniuc, Anca

AU - Carluccio, Erberto

AU - Ghio, Stefano

AU - Rossi, A.

AU - Biagioli, Paolo

AU - Reboldi, Gianpaolo

AU - Galeotti, Gian Giacomo

AU - Lu, Fei

AU - Zara, Cornelia

AU - Whalley, Gillian A.

AU - Temporelli, Pierluigi

AU - Dini, Frank L.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background B-type natriuretic peptide (BNP) and echocardiography are potentially useful adjunct to guide management of patients with chronic heart failure (HF).Thus, the aim of this retrospective, multicenter study was to compare outcomes and renal function in outpatients with chronic HF with reduced ejection fraction (HFrEF) who underwent an echo and BNP guided or a clinically driven protocol for follow-up. Methods and results In 1137 consecutive outpatients, management was guided according to echo-Doppler signs of elevated left ventricular filling pressure and BNP levels conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group in 570 (mean EF = 30%), while management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department in 567 (mean EF = 33%). Propensity score, matching several confounding baseline variables, was used to match pairs based on treatment strategy. The median follow-up was 37.4 months. After propensity matching, a lower incidence of death (HR 0.45, 95%CI: 0.30–0.67, p < 0.0001), and death or worsening renal function (HR 0.49, 95%CI 0.36–0.67, p < 0.0001) was apparent in echo-BNP-guided group compared to clinically-guided group. Worsening of renal function (≥ 0.3 mg/dl increase in serum creatinine) was observed in 9.8% of echo-BNP-guided group and in 21.4% of clinical assessed group (p < 0.0001). The daily dose of loop diuretics did not change in echo-BNP-guided group, while it increased in 65% of patients in clinically-guided group (p < 0.0001). Conclusions Echo and BNP guided management may improve the outcome and reduce worsening of renal function in outpatients with chronic HFrEF.

AB - Background B-type natriuretic peptide (BNP) and echocardiography are potentially useful adjunct to guide management of patients with chronic heart failure (HF).Thus, the aim of this retrospective, multicenter study was to compare outcomes and renal function in outpatients with chronic HF with reduced ejection fraction (HFrEF) who underwent an echo and BNP guided or a clinically driven protocol for follow-up. Methods and results In 1137 consecutive outpatients, management was guided according to echo-Doppler signs of elevated left ventricular filling pressure and BNP levels conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group in 570 (mean EF = 30%), while management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department in 567 (mean EF = 33%). Propensity score, matching several confounding baseline variables, was used to match pairs based on treatment strategy. The median follow-up was 37.4 months. After propensity matching, a lower incidence of death (HR 0.45, 95%CI: 0.30–0.67, p < 0.0001), and death or worsening renal function (HR 0.49, 95%CI 0.36–0.67, p < 0.0001) was apparent in echo-BNP-guided group compared to clinically-guided group. Worsening of renal function (≥ 0.3 mg/dl increase in serum creatinine) was observed in 9.8% of echo-BNP-guided group and in 21.4% of clinical assessed group (p < 0.0001). The daily dose of loop diuretics did not change in echo-BNP-guided group, while it increased in 65% of patients in clinically-guided group (p < 0.0001). Conclusions Echo and BNP guided management may improve the outcome and reduce worsening of renal function in outpatients with chronic HFrEF.

KW - Echocardiography

KW - Heart failure

KW - Loop diuretics

KW - Natriuretic peptides

KW - Outcomes

KW - Renal function

UR - http://www.scopus.com/inward/record.url?scp=84988843901&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84988843901&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2016.09.034

DO - 10.1016/j.ijcard.2016.09.034

M3 - Article

VL - 224

SP - 416

EP - 423

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -