Are serial BNP measurements useful in heart failure management? Serial natriuretic peptide measurements are useful in heart failure management.

To deny the fact that standard HF care has substantial opportunity for improvement is at the peril of even worse outcomes in our patients affected by the disorder. We have presented a strong rationale for the value of BNP- and NTproBNP–guided HF management. Experience gained in biomarker-guided HF trials suggests that the approach results in improvement in the quality of care without an excess of adverse events related to more aggressive management. This alone is difficult to ignore given the gaps in care that exist between RCTs and real-world practice. Beyond this fact, studies examining the strategy of biomarker-guided HF care have shown substantial improvement in outcome compared with well-managed control arms, benefits that are confirmed in meta-analysis and pooled data analyses, and justifies the imminent launch of the pivotal RCT that will lead to more widespread adoption of the approach. Compared with standard management, biomarker-guided care appears cost effective, may improve patient quality of life, and may promote reverse ventricular remodeling. Although certain subgroups such as the elderly may respond in a less vigorous manner to the approach, this may reflect the effects of age on HF therapy and how the strategy is deployed in elders rather than a weakness of the approach in older patients. A fair-minded assessment of the available data suggests that care supported by BNP/NT-proBNP–guided HF treatment—as an adjunct to standard clinical acumen—is superior to standard care. The limitation of standard care strategies is evident from the suboptimal uptake and application of proven therapies documented in HF registries. Far from being a crutch to support what we should already be doing (namely, optimally evaluating and managing our patients solely with clinical means), the inclusion of NP measurement within the HF management strategy augments the quality of monitoring and treatment. Denial of the benefits of NP monitoring potentially retards advances in the care of a high-risk population of patients that continues to grow in size and importance every day.