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

to consider further clinical trials of serial BNP testing to guide treatment."

The finding of benefit for persons aged 60 to 74 "really needs to be confirmed by other studies," Fonarow said.

BNP testing to guide heart failure treatment can be used if its role is clearly understood, said Dr. Lavoisier J. Cardozo, a professor of medicine at Wayne State University, who said he uses it routinely.

"This study says that BNP tests can tell you stuff, and clinical examinations can tell you stuff, and you can evaluate one against the other," Cardozo said.

Using clinical evaluation of symptoms to guide treatment is better in older patients, because BNP levels go up with age, Cardozo said. "Normal changes in the heart with aging confound the issue," he said. "As you age normally, you can get heart tissue trauma and that can lead to high BNP levels. If you just read the number, you tend to overtreat. We do use BNP on every patient with heart failure, and we remember that the BNP numbers for them will be slightly higher."

While BNP testing is undoubtedly useful in helping diagnose heart failure, "I think the jury is still out on its use in guiding therapy in chronic cases," said Dr. Christopher O'Connor, a professor of medicine at Duke University and director of the Duke Heart Center who co-authored an accompanying editorial.

"The trials to date have been relatively modest in statistical power," O'Connor said. "The results of this study are encouraging and do warrant a definitive, large-scale trial that I hope will be done. I think there would be a lot of enthusiasm for such a trial."

But caution is needed in using BNP tests to guide therapy in the oldest people, O'Connor noted. "Physicians might be encouraged to be too aggressive in drug therapy to reduce BNP levels, which could result in side effects and complications with drugs," he said.

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