期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 72, 期 21, 页码 2551-2562出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2018.08.2184
关键词
biomarkers; economics; heart failure; left ventricular dysfunction; quality of life
资金
- National Heart, Lung, and Blood Institute/National Institutes of Health [R01 HL105451, R01 HL105448, R01 HL105457]
- Merck
- Oxygen Therapeutics
- AstraZeneca
- University of Calgary
- Eli Lilly Company
- AGA Medical
- St. Jude Medical
- Tufts University
- GE Healthcare
- Bristol-Myers Squibb
- Pfizer
- Tenax Therapeutics
- Gilead
- Bayer
- Novartis
- Roche Diagnostics
- Abbott Diagnostics
- Siemens
- Singulex
- Prevencio
- Cleveland Heart Labs
- National Institutes of Health
- CVR Global
- ResMed
- Fibrogen
- CVRx
- Cytokinetics
- CSL Behring
- Amgen
- Luitpold
- Canadian Institutes of Health Research
- National Heart, Lung, and Blood Institute
- American Heart Association
BACKGROUND The GUIDE-IT (GUIDing Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) trial prospectively compared the efficacy of an N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided heart failure treatment strategy (target NT-proBNP level <1,000 pg/ml) with optimal medical therapy alone in high-risk patients with heart failure and reduced ejection fraction. When the study was stopped for futility, 894 patients had been enrolled. OBJECTIVES The purpose of this study was to assess treatment-related quality-of-life (QOL) and economic outcomes in the GUIDE-IT trial. METHODS The authors prospectively collected a battery of QOL instruments at baseline and 3, 6, 12, and 24 months post-randomization (collection rates 90% to 99% of those eligible). The principal pre-specified QOL measures were the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score and the Duke Activity Status Index (DASI). Cost data were collected for 735 (97%) U.S. patients. RESULTS Baseline variables were well balanced in the 446 patients randomized to the NT-proBNP-guided therapy and 448 to usual care. Both the KCCQ and the DASI improved over the first 6 months, but no evidence was found for a strategy-related difference (mean difference [biomarker-guided - usual care] at 24 months of follow-up 2.0 for DASI [95% confidence interval (CI): -1.3 to 5.3] and 1.1 for KCCQ [95% CI: -3.7 to 5.9]). Total winsorized costs averaged $5,919 higher in the biomarker-guided strategy (95% CI: -$1,795, +$13,602) over 15-month median follow-up. CONCLUSIONS A strategy of NT-proBNP-guided HF therapy had higher total costs and was not more effective than usual care in improving QOL outcomes in patients with heart failure and a reduced ejection fraction. (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment [GUIDE-IT]; NCT01685840) (c) 2018 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.
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