Abstract
Introduction: In hospitalized patients with heart failure (HF), the transition period after discharge is associated with high risk of adverse events. The impact of monitoring natriuretic peptides (NP) in patients with preserved LVEF (HFpEF) has not specifically studied. Methods: NICE trial (NCT02807168) is a randomized, open-label, blinded for events and multicenter study. The study population included hospitalized patients with HFpEF (LVEF>50% and at least one additional criteria of diastolic dysfunction). Patients were randomized at discharge into intervention (NP group) or control group. Both groups received optimal therapy and scheduled clinical visits at 14 and 30 days, 3 and 6 months, and NT-proBNP results were available for the clinician only in the intervention group. Results: 157 patients (76±8 years, 61% female, LVEF 61±7%) were randomized into NP group (n=79) and control group (n=78). Baseline characteristics did not differ between groups. At 6 months, no differences were found in HF readmission in NP vs. control group (12.8% vs. 11.4%, HR 1.15, CI95% 0.47-2.81), or any episode of worsening HF (20.5% vs. 24.1%, HR 0.89, CI95% 0.44-1.82). NP group had a significantly lower mortality than the control group (1.3% vs. 10.1%, HR 0.12, IC95% 0.02-0.98, p=0.048), as well as a trend to lower risk of hospitalization for non-HF related causes (12.8% vs. 19.0%, HR 0.68, IC95% 0.39-1.18). Considering the composite end-point (death or worsening HF), the intervention with NT-proBNP was associated with a lower risk trend (20.5% vs. 30.4%, HR 0.65, IC95% 0.34-1.22, p=0.181). Regarding the use of medical therapies, diuretic and ACEI doses were higher in the intervention group during the follow-up. Conclusions: In hospitalized patients with HFpEF, NT-proBNP availability during the transition period did not reduce the risk of HF readmissions. Nevertheless, it was associated with a lower mortality. These results suggest a global impact in the disease, beyond readmissions.
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