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Monitoring Protein Didn't Improve Heart Failure Outcomes
Date:1/27/2009

Study finds just watching symptoms leads to similar survival rates in older patients

TUESDAY, Jan. 27 (HealthDay News) -- Using the biomarker molecule known as brain natriuretic peptide (BNP) to guide treatment for older people with chronic heart failure did not improve the clinical outcome in most cases in a Swiss study.

There have been conflicting reports about the value of monitoring blood levels of BNP, a protein produced by stressed heart cells, for better management of heart failure. For example, a French study reported in 2007 found that BNP monitoring reduced deaths and hospitalizations in a 115-participant trial.

But the new study, published in the Jan. 28 issue of the Journal of the American Medical Association by physicians at University Hospital Basel, found that BNP-monitored therapy guidance generally did not improve 18-month survival or quality of life over conventional symptom-guided therapy.

All the people in the trial were 60 or older. All were hospitalized for heart failure, and all had BNP blood levels at least double the normal readings.

Some improvement over symptom-guided treatment was found with BNP-guided therapy for those 60 to 74, but not for those aged 75 and older.

Despite those results, BNP measurement does have a role in diagnosis and treatment of heart failure, said Dr. Gregg C. Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles.

"It is very useful in diagnosing heart failure," Fonarow said. "When someone shows up in an emergency room, BNP testing will help determine whether the cause is heart failure. Whether serial testing will improve clinical outcome remains unknown and is worthy of further study."

The Swiss trial is not definitive, because it was relatively small, with only 499 participants, Fonarow said. "All the studies to date have been rather small," he said. "It is certainly worthwhile
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