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  • Effect of Natriuretic Peptide–Guided Therapy on Hospitalization or Cardiovascular Mortality in High-Risk Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial

    Abstract Full Text
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    JAMA. 2017; 318(8):713-720. doi: 10.1001/jama.2017.10565

    This randomized clinical trial investigates whether reducing natriuretic peptide levels by titrating medication to reach the target of less than 1000 pg/mL in patients with heart failure and reduced ejection fraction improves clinical outcomes.

  • JAMA August 22, 2017

    Figure 3: Change in NT-proBNP Levels

    NT-proBNP indicates amino-terminal pro–B-type natriuretic peptide. Laboratory values were not available from all participants.
  • JAMA April 19, 2016

    Figure 4: Serial Biomarker Concentrations

    Concentration of high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro–brain natriuretic peptide (NT-pro-BNP) over time with losmapimod vs placebo. The errors bars indicate the 95% confidence interval around the geometric mean. For hs-CRP, P<.001 for losmapimod vs placebo at 48 hours and at week 12; P=.004 at week 4. For NT-pro-BNP, P<.001 for losmapimod vs placebo at week 4 and at week 12.
  • JAMA December 1, 2015

    Figure 1: Flow of Patients Through the Trial

    NT-proBNP indicates N-terminal pro-B-type natriuretic peptide; BNP, B-type natriuretic peptide; BP, blood pressure; LVEF, left ventricular ejection fraction; eGFR, estimated glomerular filtration rate.aOne patient in the 2.5-mg vericiguat group was too old according to local regulation (initial age limit <75 y, later suspended).bMajor reasons for exclusion. Each patient may have >1 reason for exclusion.
  • B-Type Natriuretic Peptide for the Evaluation of Volume Status in Elderly Postoperative Patients

    Abstract Full Text
    JAMA. 2014; 311(19):2017-2018. doi: 10.1001/jama.2013.7300
  • Natriuretic Peptide–Based Screening and Collaborative Care for Heart Failure: The STOP-HF Randomized Trial

    Abstract Full Text
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    JAMA. 2013; 310(1):66-74. doi: 10.1001/jama.2013.7588

    Ledwidge and coauthors conducted a randomized trial among 1374 at-risk patients in Ireland to determine the efficacy of a screening program using brain-type natriuretic peptide (BNP) and collaborative care in reducing newly diagnosed heart failure and prevalence of significant left ventricular systolic/diastolic dysfunction. In an Editorial, Hernandez discusses heart failure prevention.

  • JAMA July 3, 2013

    Figure 1: Participant Flow

    BNP indicates brain-type natriuretic peptide.
  • JAMA July 3, 2013

    Figure 2: Kaplan-Meier Analysis of Major Adverse Cardiovascular Events in the Full Study Sample and in Participants With BNP ≥50 pg/mL

    BNP indicates brain-type natriuretic peptide. Major adverse cardiovascular events included arrhythmia, transient ischemic attack, stroke, myocardial infarction, peripheral or pulmonary thrombosis/embolus, or heart failure. In the full sample, 51 (7.3%) of 697 patients were admitted for major adverse cardiovascular events in the intervention group and 71 (10.5%) of 677 were admitted in the control group. In participants with BNP ≥50 pg/mL, 35 (13.3%) of 263 were admitted for major adverse cardiovascular events in the intervention group and 45 (19.1%) of 235 were admitted in the control group.
  • JAMA May 26, 2010

    Figure 1: Treatment Failure for Early Antibiotic Treatment vs Late or No Treatment

    Subgroup analyses are presented according to whether patients had a sputum test or arterial blood gas measurement on hospital day 1 or 2 and also by risk tertile for treatment failure. aCovariates include age group, sex, insurance, respiratory failure as a principle diagnosis, attending physician specialty, admission source, prior year admissions for acute exacerbation chronic obstructive pulmonary disease, region, chronic pulmonary heart disease, hypertension, heart failure, pulmonary circulation disease, metastatic cancer, arthritis, obesity, weight loss, deficiency anemia, hypothyroid, depression, psychoses, alcohol abuse, and day 1 or 2 initiation of long-acting β2 agonists, bilevel positive airway pressure or continuous positive airway pressure, methylxanthine bronchodilators, oral or intravenous steroids, morphine, loop diuretics, arterial blood gas measurements, brain natriuretic peptide, pulmonary function tests, and selected interaction terms.bCovariates include race, insurance status, respiratory failure as principal diagnosis, attending physician specialty, region, population served, chronic pulmonary heart disease, heart failure, diabetes, hypothyroid, renal failure, drug abuse, and day 1 or 2 initiation of anticholinergic or short-acting β2 agonists, long-acting β2 agonists, methylxanthine bronchodilators, bilevel positive airway pressure or continuous positive airway pressure, oral or intravenous steroids, morphine, loop diuretics, mucolytic medications, arterial blood gases, brain natriuretic peptide, and pulmonary function tests. cRisk of treatment failure tertiles are first: 0.008-0.059; second: 0.060-0.102; third: 0.103-0.838.
  • JAMA July 1, 2009

    Figure: One Minus Cumulative Cardiovascular and Coronary Event-Free Survival During Follow-up in Quartiles of a Multimarker Score Based on Summed Standardized Values of Biomarkers

    Quartile 1 represents participants having lowest summed standardized values of biomarkers expressed as the number of SD deviations from the mean. Median (range) multimarker scores in each quartile for cardiovascular events were −1.66 (−5.47 to −1.01), −0.52 (−1.01 to −0.04), 0.37 (−0.04 to 0.90), and 1.65 (0.90 to 5.62). Median (range) multimarker scores in each quartile for coronary events were −1.62 (−5.14 to −1.02), −0.50 (−1.02 to −0.06), 0.38 (−0.06 to 0.88), and 1.60 (0.88 to 11.65). CRP indicates C-reactive protein; MR-proADM, midregional proadrenomedullin; N-BNP, N-terminal pro-B-type natriuretic peptide.
  • JAMA January 28, 2009

    Figure 3: Symptoms and N-Terminal Brain Natriuretic Peptide (BNP) Levels at Baseline and Month 6

    A, Symptoms expressed as NYHA class. B, N-terminal BNP levels. Boxes indicate interquartile range; horizontal lines, median; error bars, 10th and 90th percentiles. The improvements by both treatment strategies were significant in both age groups (all P < .001). There were no significant differences between the 2 treatment groups by age for symptoms (P = .11 for <75 years vs P = .38 for ≥75 years) or by N-terminal BNP level (P = .06 vs P = .30).
  • JAMA January 28, 2009

    Figure 4: Relationship Between Symptoms and N-Terminal Brain Natriuretic Peptide (BNP) Levels

    Relationship between New York Heart Association (NYHA) class and N-terminal BNP levels at visits from baseline to month 12 of all patients showing higher N-terminal BNP levels with higher NYHA class (Spearman r = 0.36, P<.001) and a trend to lower N-terminal BNP levels within each NYHA class from baseline to month 12 (NYHA I: Spearman r = 0.34, P = .001; NYHA II: Spearman r = −0.21, P<.001; NYHA III: Spearman r = −0.15, P<.001; NYHA IV: Spearman r = 0.04, P = .69).
  • BNP-Guided vs Symptom-Guided Heart Failure Therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial

    Abstract Full Text
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    JAMA. 2009; 301(4):383-392. doi: 10.1001/jama.2009.2
  • JAMA January 28, 2009

    Figure 1: Flow of Participants Through the Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure

    BNP indicates brain natriuretic peptide; LVEF, left ventricular ejection fraction.
  • JAMA January 28, 2009

    Figure 5: Primary and Secondary Outcomes in the 2 Treatment Groups

    NT-BNP indicates N-terminal brain natriuretic peptide; CI, confidence interval; HF, heart failure; HR, hazard ratio.
  • JAMA January 28, 2009

    Figure 2: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin II Receptor Blocker (ARB) and β-Blocker Doses During the Study

    BNP indicates brain natriuretic peptide. Error bars indicate standard error of the mean. P < .001 for the differences between the treatment groups for both age groups.
  • JAMA January 28, 2009

    Figure 6: Treatment Effects on Main Outcomes in Younger Compared With Older Patients

    The differences between treatment groups were observed only in younger but not older patients. NT-BNP indicates N-terminal brain natriuretic peptide; CI, confidence interval; HF, heart failure; HR, hazard ratio.
  • JAMA January 28, 2009

    Figure 7: Interactions Between Baseline Characteristics and Treatments Relative to Main Outcomes

    Subgroup analysis between the age groups was prespecified. Values for body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), N-terminal BNP, and creatinine were subdivided by median values. The size of the data markers represents the number of patients in each group. BNP indicates brain natriuretic peptide; CI, confidence interval; HF, heart failure; HR, hazard ratio. aP < .05 for interaction. bP < .10 for interaction.
  • BNP-Guided Therapy for Heart Failure

    Abstract Full Text
    JAMA. 2009; 301(4):432-434. doi: 10.1001/jama.2009.3
  • JAMA May 2, 2007

    Figure 3: Mean Change From Baseline in B-Type Natriuretic Peptide Levels at 1, 3, and 5 Days by Treatment Group

    There was a significantly greater mean (SE) change from baseline in plasma B-type natriuretic peptide levels in the levosimendan group compared with the dobutamine group at 1, 3, and 5 days after initiation of study drug infusion. P<.001 at all 3 time points. Statistical significance was determined using Kruskal-Wallis test with treatment effect.