Abstract
Objective: The importance of the NT-proBNP value in detecting patients at risk of developing heart failure (HF) and its importance in guiding medical management to prevent the development of HF. Material and methods: The study is a prospective study and includes 314 patients who was presented at the Bagdasar-Arseni Emergency Hospital for cardiology consultation, by appointment, for a period of 3 years. The inclusion criteria were as follows: essential hypertension (diagnosed more than 5 years before), diabetes mellitus (insulin-deficient or under treatment with oral ant diabetics diagnosed more than 5 years before), ischemic heart disease, mild or moderate valvulopathy (mild or moderate mitral regurgitation and large or moderate aortic stenosis) and permanent or paroxysmal atrial fibrillation. Exclusion criteria were as follows: a previous diagnosis of heart failure or left ventricular systolic dysfunction, and the presence of signs or symptoms of heart failure at the time of enrollment in the study. Patients were randomized into 2 groups, a control group and a intervention group. Patients in the intervention group were managed according to the NT-proBNP value, and patients in the control group received the conventional intervention. Patients were monitored for 3 years and the following objectives were pursued: new diagnosis of heart failure, systolic or diastolic dysfunction of the left ventricle and hospitalization for cardiovascular pathology. Results: After 3 years, in the control group there were 40 patients (25.5%) who developed HF, compared to 28 patients (17.8%) in the intervention group. In the control group, 60 patients (38.2%) were diagnosed with left ventricular systolic dysfunction, compared to 43 patients (27.4%) in the intervention group. Regarding left ventricular diastolic dysfunction, in the control group there were 98 patients (62.4%), and in the intervention group there were 80 patients (51.0%). Also, the rate of hospitalizations for cardiovascular pathology was higher in the control group, 56 patients (35.7%), compared to 33 patients (21.0%) in the intervention group. Discussions: The incidence of heart failure, left ventricular systolic or diastolic dysfunction, or hospitalizations for cardiovascular events, was lower in the intervention group, in which patients were managed according to the NT-proBNP value, compared to patients in the control group who received conventional intervention. Conclusions: The NT-proBNP biomarker may be useful in the medical management of patients for the prevention of heart failure.
Highlights
Heart failure (HF) is a major public health issue worldwide
The goal of this study is to determine the relevance of NT-proBNP determination in patients without heart failure, but with conditions that may develop into heart failure, to guide therapeutic conduct and prevention of HF or left ventricular (LV) systolic dysfunction
Patients were managed according to the NT-proBNP value, and in the control group patients received indications and conventional treatment of complaints for which they presented
Summary
Heart failure (HF) is a major public health issue worldwide. In Europe, about 1% of national health budgets are used to treat patients with heart failure 1. In America, as well as in Romania, HF is the leading cause of hospitalization in patients over 65 years[1,2]. Heart failure is a condition that currently consumes a lot of money and imported resources for treatment, repeated hospitalizations, required surgeries or the management of complications. The prevalence and incidence of HF have been increasing and it is believed that this upward trend will continue 3. 4.7% of the population over 35 in Romania suffers from HF and every hour 5 new cases of HF are diagnosed[2]. 64.3 million people worldwide suffer from HF, the percentages varying between 1 and 4%4,5, depending on the country
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