# NT-proBNP-geleide therapie bij acuut gedecompenseerd hartfalen: PRIMA II

*geplaatst 2018-04-17 · Hartfalen · Circulation · doi 10.1161/CIRCULATIONAHA.117.029882 · https://hartvaat.nl/2018/04/17/nt-probnp-geleide-therapie-bij-acuut-gedecompenseerd-hartfalen-prima-ii/*

PRIMA II gerandomiseerde trial naar NT-proBNP-geleide therapie bij acuut gedecompenseerd hartfalen. Geen voordeel van biomarker-geleide intensivering in de acute fase.

## English: NT-proBNP (N-Terminal pro-B-Type Natriuretic Peptide)-Guided Therapy in Acute Decompensated Heart Failure: PRIMA II Randomized Controlled Trial (Can NT-ProBNP-Guided Therapy During Hospital Admission for Acute Decompensated Heart Failure Reduce Mortality and Readmissions?).

The PRIMA II trial showed that NT-proBNP-guided therapy in acute decompensated heart failure did not improve outcomes compared with clinically guided management, adding to the evidence against routine biomarker-guided treatment titration in acute HF.

## Abstract (original, from the publication)

BACKGROUND: The concept of natriuretic peptide guidance has been extensively studied in patients with chronic heart failure (HF), with only limited success. The effect of NT-proBNP (N-terminal probrain natriuretic peptide)-guided therapy in patients with acute decompensated HF using a relative NT-proBNP target has not been investigated. This study aimed to assess whether NT-proBNP-guided therapy of patients with acute decompensated HF using a relative NT-proBNP target would lead to improved outcomes compared with conventional therapy. METHODS: We conducted a prospective randomized controlled trial to study the impact of in-hospital guidance for acute decompensated HF treatment by a predefined NT-proBNP target (>30% reduction from admission to discharge) versus conventional treatment. Patients with acute decompensated HF with NT-proBNP levels >1700 ng/L were eligible. After achieving clinical stability, 405 patients were randomized to either NT-proBNP-guided or conventional treatment (1:1). The primary end point was dual: a composite of all-cause mortality and HF readmissions in 180 days and the number of days alive out of the hospital in 180 days. Secondary end points were all-cause mortality within 180 days, HF readmissions within 180 days, and a composite of all-cause mortality and HF readmissions within 90 days. RESULTS: Significantly more patients in the NT-proBNP-guided therapy group were discharged with an NT-proBNP reduction of >30% (80% versus 64%, P=0.001). Nonetheless, NT-proBNP-guided therapy did not significantly improve the combined event rate for all-cause mortality and HF readmissions (hazard ratio, 0.96; 95% confidence interval, 0.72-1.37; P=0.99) or the median number of days alive outside of the hospital (178 versus 179 days for NT-proBNP versus conventional patients, P=0.39). Guided therapy also did not significantly improve any of the secondary end points. CONCLUSIONS: The PRIMA II trial (Can NT-ProBNP-Guided Therapy During Hospital Admission for Acute Decompensated Heart Failure Reduce Mortality and Readmissions?) demonstrates that the guidance of HF therapy to reach an NT-proBNP reduction of >30% after clinical stabilization did not improve 6-month outcomes. CLINICAL TRIAL REGISTRATION: URL: http://www.trialregister.nl. Unique identifier: NTR3279.

Auteurs: Susan Stienen, Khibar Salah, Arno H Moons, Adrianus L Bakx, Petra van Pol, R A Mikael Kortz, João Pedro Ferreira, Irene Marques, Jutta M Schroeder-Tanka, Jan T Keijer, Antoni Bayés-Genis, Jan G P Tijssen, Yigal M Pinto, Wouter E Kok

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Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.117.029882. Bijgewerkt 2026-07-03T18:38:37Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.