Heart failure & cardiomyopathiesCohort study
Optimizing NT-proBNP Inclusion Cut-offs for Randomized Clinical Trials in Heart Failure: Data from the Swedish Heart Failure Registry
- registry-based analysis
- Swedish heart failure (HF) Registry (SwedeHF)
Authors' conclusion
Higher NT-proBNP cut-offs were associated with increased event enrichment but also higher screening failure. These findings support the use of higher cut-offs currently used in HF RCTs and suggest that future trials should tailor NT-proBNP cut-offs to trial aims, balancing enrichment with enrolment feasibility and considering obesity and CKD in addition to EF and AF.
Study context
- Population
- Heart failure patients in the Swedish HF Registry
- Participants
- 43,750 HF patients
- Exposure
- NT-proBNP cut-offs from prior randomized controlled trials (RCTs) (200-5000 pg/mL) across subgroups by ejection fraction (EF), care setting, atrial fibrillation (AF), chronic kidney disease (CKD) and obesity
Main finding
As reported in the abstract
Median NT-proBNP lower in HFpEF/HFmrEF vs HFrEF, outpatients vs inpatients, sinus rhythm vs AF, obese vs not obese, and patients without CKD vs with CKD
all p < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| 1-year composite CV proportion in HFrEF outpatients | no cut-off 22.0% · ≥600 pg/mL 24.3% · ≥1,200 pg/mL 26.2% |
| Screening failure in HFrEF outpatients | ≥600 pg/mL 16.0% · ≥1,200 pg/mL 26.4% |
- 1-year composite CV proportion in HFrEF outpatients — relative increase
- 19% (95% CI:14.0-24.4)
1-year composite CV outcome (CV death or first HF hospitalisation) by cut-off
- Higher NT-proBNP cut-offs increased 1-year composite CV proportions but excluded more patients
Optimal prognostic thresholds (Youden's index)
- Optimal prognostic thresholds aligned with or exceeded subgroup median NT-proBNP values
Original publication
Summarised from the published abstract; every number is checked against it