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Which heart failure...
Which heart failure patients profit from natriuretic peptide guided therapy? A meta-analysis from individual patient data of randomized trials.
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- Brunner-La Rocca, Hans-Peter (författare)
- Maastricht University Medical Centre, Maastricht, the Netherlands
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- Eurlings, Luc (författare)
- Maastricht University Medical Centre, Maastricht, the Netherlands
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- Richards, A Mark (författare)
- National University Heart Centre, Singapore
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- Januzzi, James L (författare)
- Massachusetts General Hospital, Boston, MA, USA
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Pfisterer, Matthias E (författare)
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- Dahlström, Ulf (författare)
- Östergötlands Läns Landsting,Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Kardiologiska kliniken US
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- Pinto, Yigal M (författare)
- Academic Medical Centre, Amsterdam, the Netherlands
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- Karlström, Patric (författare)
- County Hospital Ryhov, Jonkoping, Sweden
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- Erntell, Hans (författare)
- Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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- Berger, Rudolf (författare)
- Medical University of Vienna, Vienna, Austria
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- Persson, Hans (författare)
- Karolinska Institutet
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- O'Connor, Christopher M (författare)
- LKH, St Poelten, Austria.
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- Moertl, Deddo (författare)
- Massachusetts General Hospital, Boston, MA, USA
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- Gaggin, Hanna K (författare)
- Massachusetts General Hospital, Boston, MA, USA
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- Frampton, Christopher M (författare)
- University of Otago Christchurch, Christchurch Hospital, Christchurch, New Zealand.
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- Nicholls, M Gary (författare)
- University of Otago Christchurch, Christchurch Hospital, Christchurch, New Zealand.
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- Troughton, Richard W (författare)
- University of Otago Christchurch, Christchurch Hospital, Christchurch, New Zealand.
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(creator_code:org_t)
- 2015-09-30
- 2015
- Engelska.
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 17:12, s. 1252-1261
- Relaterad länk:
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https://onlinelibrar...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- AIMS: Previous analyses suggest that heart failure (HF) therapy guided by (N-terminal pro-)brain natriuretic peptide (NT-proBNP) might be dependent on left ventricular ejection fraction, age and co-morbidities, but the reasons remain unclear.METHODS AND RESULTS: To determine interactions between (NT-pro)BNP-guided therapy and HF with reduced [ejection fraction (EF) ≤45%; HF with reduced EF (HFrEF), n = 1731] vs. preserved EF [EF > 45%; HF with preserved EF (HFpEF), n = 301] and co-morbidities (hypertension, renal failure, chronic obstructive pulmonary disease, diabetes, cerebrovascular insult, peripheral vascular disease) on outcome, individual patient data (n = 2137) from eight NT-proBNP guidance trials were analysed using Cox-regression with multiplicative interaction terms. Endpoints were mortality and admission because of HF. Whereas in HFrEF patients (NT-pro)BNP-guided compared with symptom-guided therapy resulted in lower mortality [hazard ratio (HR) = 0.78, 95% confidence interval (CI) 0.62-0.97, P = 0.03] and fewer HF admissions (HR = 0.80, 95% CI 0.67-0.97, P = 0.02), no such effect was seen in HFpEF (mortality: HR = 1.22, 95% CI 0.76-1.96, P = 0.41; HF admissions HR = 1.01, 95% CI 0.67-1.53, P = 0.97; interactions P < 0.02). Age (74 ± 11 years) interacted with treatment strategy allocation independently of EF regarding mortality (P = 0.02), but not HF admission (P = 0.54). The interaction of age and mortality was explained by the interaction of treatment strategy allocation with co-morbidities. In HFpEF, renal failure provided strongest interaction (P < 0.01; increased risk of (NT-pro)BNP-guided therapy if renal failure present), whereas in HFrEF patients, the presence of at least two of the following co-morbidities provided strongest interaction (P < 0.01; (NT-pro)BNP-guided therapy beneficial only if none or one of chronic obstructive pulmonary disease, diabetes, cardiovascular insult, or peripheral vascular disease present). (NT-pro)BNP-guided therapy was harmful in HFpEF patients without hypertension (P = 0.02).CONCLUSION: The benefits of therapy guided by (NT-pro)BNP were present in HFrEF only. Co-morbidities seem to influence the response to (NT-pro)BNP-guided therapy and may explain the lower efficacy of this approach in elderly patients.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
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Brunner-La Rocca ...
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Eurlings, Luc
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Richards, A Mark
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Januzzi, James L
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Pfisterer, Matth ...
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Dahlström, Ulf
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Pinto, Yigal M
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Karlström, Patri ...
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Erntell, Hans
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Berger, Rudolf
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Persson, Hans
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O'Connor, Christ ...
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Moertl, Deddo
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Gaggin, Hanna K
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Frampton, Christ ...
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Nicholls, M Gary
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Troughton, Richa ...
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