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首页> 外文期刊>JAMA: the Journal of the American Medical Association >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.
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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.

机译：BNP指导与症状指导的心力衰竭治疗：老年充血性心力衰竭患者（TIME-CHF）的随机对照试验。

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CONTEXT: It is uncertain whether intensified heart failure therapy guided by N-terminal brain natriuretic peptide (BNP) is superior to symptom-guided therapy. OBJECTIVE: To compare 18-month outcomes of N-terminal BNP-guided vs symptom-guided heart failure therapy. DESIGN, SETTING, AND PATIENTS: Randomized controlled multicenter Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) of 499 patients aged 60 years or older with systolic heart failure (ejection fraction < or = 45%), New York Heart Association (NYHA) class of II or greater, prior hospitalization for heart failure within 1 year, and N-terminal BNP level of 2 or more times the upper limit of normal. The study had an 18-month follow-up and it was conducted at 15 outpatient centers in Switzerland and Germany between January 2003 and June 2008. INTERVENTION: Uptitration of guideline-based treatments to reduce symptoms to NYHA class of II or less (symptom-guided therapy) and BNP level of 2 times or less the upper limit of normal and symptoms to NYHA class of II or less (BNP-guided therapy). MAIN OUTCOME MEASURES: Primary outcomes were 18-month survival free of all-cause hospitalizations and quality of life as assessed by structured validated questionnaires. RESULTS: Heart failure therapy guided by N-terminal BNP and symptom-guided therapy resulted in similar rates of survival free of all-cause hospitalizations (41% vs 40%, respectively; hazard ratio [HR], 0.91 [95% CI, 0.72-1.14]; P = .39). Patients' quality-of-life metrics improved over 18 months of follow-up but these improvements were similar in both the N-terminal BNP-guided and symptom-guided strategies. Compared with the symptom-guided group, survival free of hospitalization for heart failure, a secondary end point, was higher among those in the N-terminal BNP-guided group (72% vs 62%, respectively; HR, 0.68 [95% CI, 0.50-0.92]; P = .01). Heart failure therapy guided by N-terminal BNP improved outcomes in patients aged 60 to 75 years but not in those aged 75 years or older (P < .02 for interaction) CONCLUSION: Heart failure therapy guided by N-terminal BNP did not improve overall clinical outcomes or quality of life compared with symptom-guided treatment. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN43596477.
机译：背景：尚不确定由N末端脑钠肽（BNP）引导的强化心力衰竭治疗是否优于症状引导治疗。目的：比较N端BNP引导和症状引导性心力衰竭治疗的18个月预后。设计，地点和患者：499名年龄在60岁或以上的收缩性心力衰竭（射血分数<或= 45％）的499例充血性心力衰竭（TIME-CHF）老年患者的强化与标准药物治疗随机对照多中心试验，纽约心脏协会（NYHA）的II级或更高级别，因心力衰竭住院的患者在1年内住院，并且N端BNP水平是正常上限的2倍或更多倍。这项研究进行了18个月的随访，于2003年1月至2008年6月在瑞士和德国的15个门诊中心进行。干预：采用基于指南的治疗方法以减少症状至NYHA II级或以下（症状为-指导治疗），且BNP水平为正常和症状上限的2倍或更低，至NYHA II类或更低（BNP指导治疗）。主要观察指标：主要结局为18个月生存期，无因各种原因导致的住院和生活质量，这是通过结构化的有效调查表评估得出的。结果：N端BNP指导的心力衰竭治疗和症状指导治疗导致无原因住院的相似存活率（分别为41％和40％;危险比[HR]，0.91 [95％CI，0.72] -1.14]; P = 0.39）。在18个月的随访中，患者的生活质量指标有所改善，但这些改善在N端BNP指导和症状指导策略中均相似。与症状指导组相比，N末端BNP指导组的患者因心力衰竭而住院的生存率（次要终点）更高（分别为72％和62％; HR，0.68 [95％CI ，0.50-0.92]; P = .01）。 N端BNP指导的心力衰竭治疗可改善60至75岁患者的预后，但75岁或75岁以上患者则无此效果（交互作用P <.02）结论：N端BNP指导的心力衰竭治疗不能整体改善与症状指导治疗相比的临床结局或生活质量。试用注册：isrctn.org标识符：ISRCTN43596477。

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