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Am Heart J. 2014 Jul;168(1):30-6. doi: 10.1016/j.ahj.2014.04.008. Epub 2014 Apr 23.

Rationale and design of PRIMA II: A multicenter, randomized clinical trial to study the impact of in-hospital guidance for acute decompensated heart failure treatment by a predefined NT-PRoBNP target on the reduction of readmIssion and Mortality rAtes.

Author information

1
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
2
Department of Cardiology, Slotervaartziekenhuis, Amsterdam, The Netherlands.
3
Department of Cardiology, BovenIJ Ziekenhuis, Amsterdam, The Netherlands.
4
Department of Cardiology, Rijnland Ziekenhuis, Leiderdorp, The Netherlands.
5
Department of Cardiology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
6
Department of Cardiology, Spaarne Ziekenhuis, Hoofddorp, The Netherlands.
7
Department of Cardiology, Tergooiziekenhuizen, Blaricum, The Netherlands.
8
Department of Cardiology, Flevoziekenhuis, Almere, The Netherlands.
9
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: w.e.kok@amc.uva.nl.

Abstract

BACKGROUND:

Hospital admissions for acute decompensated heart failure (ADHF) are frequent and are accompanied by high percentages of mortality and readmissions. Brain natriuretic peptide (BNP) and the inactive N-terminal fragment of its precursor proBNP (NT-proBNP) are currently the best predictors of prognosis in heart failure (HF) patients. In the setting of chronic HF, studies that performed guidance of therapy by NT-proBNP have had only limited success. For patients with ADHF, retrospective studies have shown that a reduction in NT-proBNP of ≤30% during admission is a significant predictor of HF readmissions and mortality. These data suggest a role for NT-proBNP guidance in the setting of ADHF admissions.

STUDY DESIGN:

The PRIMA II is an investigator-initiated, multicenter, randomized, controlled, prospective 2-arm trial that investigates the impact of inhospital guidance for ADHF treatment by a predefined NT-proBNP target (>30% reduction during admission) on the reduction of readmission and mortality rates within 180 days. Consenting ADHF patients with NT-proBNP levels of >1,700 ng/L are eligible. After achieving clinical stability, a total of 340 patients are randomized to either NT-proBNP-guided or conventional treatment (1:1). The primary end point is dual, that is, a composite of all-cause mortality and readmission for HF in 180 days and the number of days alive out of hospital in 180 days. Secondary end points are readmissions and/or mortality in 180 days, cost effectiveness of hospitalization days in 180 days, readmissions and mortality in 90 days, and quality of life.

CONCLUSION:

The PRIMA II trial aims at providing scientific evidence for the use of NT-proBNP-guided therapy compared with conventional treatment in patients admitted for ADHF.

PMID:
24952857
DOI:
10.1016/j.ahj.2014.04.008
[Indexed for MEDLINE]

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