Bias in natriuretic peptide-guided heart failure trials: time to improve guideline adherence using alternative approaches.
Fiche publication
Date publication
août 2020
Journal
Heart failure reviews
Auteurs
Membres identifiés du Cancéropôle Est :
Pr ROSSIGNOL Patrick
Tous les auteurs :
Stienen S, Bhatt A, Ferreira JP, Vaduganathan M, Januzzi J, Adams K, Tardif JC, Rossignol P, Zannad F
Lien Pubmed
Résumé
Treatment of patients with heart failure with reduced ejection fraction (HFrEF) with currently available therapies reduces morbidity and mortality. However, implementation of these therapies is a problem with only few patients achieving guideline-recommended maximal doses of therapy. In an effort to improve guideline adherence and uptitration, several trials have investigated a biomarker-guided strategy (using natriuretic peptide targets in specific), but although conceptually promising, these trials failed to show a consistent beneficial effect on outcomes. In this review, we discuss different methodological issues that may explain the failure of these trials and offer potential solutions. Moreover, alternative approaches to increase heart failure guideline adherence are evaluated.
Mots clés
Adherence, Bias, Biomarker, Biomarker-guided trials, Guideline-directed, HFrEF, Medical therapy, Natriuretic peptides
Référence
Heart Fail Rev. 2020 Aug 12;: