# NT-proBNP-afkapwaarden voor hartfalentrials optimaliseren (SwedeHF)

*geplaatst 2026-03-27 · Hartfalen · ESC heart failure · doi 10.1093/eschf/xvag089 · https://hartvaat.nl/2026/03/27/nt-probnp-afkapwaarden-voor-hartfalentrials-optimaliseren-swedehf/*

NT-proBNP wordt veel gebruikt als inclusiecriterium in hartfalentrials, maar de afkapwaarden lopen sterk uiteen. Met het Zweedse hartfalenregister (SwedeHF, 43.750 patiënten) zijn afkapwaarden uit eerdere trials (200–5.000 pg/ml) toegepast en is de 1-jaars-incidentie van cardiovasculaire sterfte of hartfalenopname per subgroep berekend (ejectiefractie, klinische setting, AF, CKD, obesitas). Hogere afkapwaarden verhoogden de event-verrijking, maar sloten ook meer patiënten uit (meer screen-failures). Bij poliklinische HFrEF-patiënten steeg de 1-jaars-incidentie van 22,0% (geen afkap) naar 26,2% bij ≥1.200 pg/ml, ten koste van 26% screen-failure. De auteurs adviseren de afkapwaarden af te stemmen op het trialdoel en daarbij obesitas en CKD mee te wegen.

## English: Optimizing NT-proBNP Inclusion Cut-offs for Randomized Clinical Trials in Heart Failure: Data from the Swedish Heart Failure Registry

NT-proBNP is widely used as an enrolment criterion in heart-failure trials, but cut-offs vary widely. Using the Swedish Heart Failure Registry (SwedeHF, 43,750 patients), the investigators applied prior-trial cut-offs (200–5,000 pg/mL) and computed the 1-year incidence of cardiovascular death or heart-failure hospitalisation across subgroups (ejection fraction, care setting, AF, CKD, obesity). Higher cut-offs increased event enrichment but excluded more patients (more screening failures). In HFrEF outpatients, 1-year incidence rose from 22.0% (no cut-off) to 26.2% at ≥1,200 pg/mL, at the cost of 26% screening failure. The authors advise tailoring cut-offs to trial aims while accounting for obesity and CKD.

## Abstract (original, from the publication)

AIMS: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is widely used as an enrichment criterion in heart failure (HF) randomized controlled trials (RCTs), yet cut-offs vary. This study aims to provide evidence-based guidance on selecting NT-proBNP cut-offs to optimize the balance between event enrichment and screening failure across HF subgroups. METHODS: Using the Swedish HF Registry (SwedeHF), we applied NT-proBNP cut-offs from prior RCTs (200-5000 pg/mL) and calculated 1-year incidence proportions of a composite CV outcome (CV death or first HF hospitalisation) across subgroups by ejection fraction (EF), care setting (inpatient/outpatient), atrial fibrillation (AF), chronic kidney disease (CKD), and obesity. We quantified point and relative increases in event proportions and potential screening failure at each cut-off and identified optimal prognostic thresholds by maximizing Youden's index. RESULTS: Among 43,750 HF patients, median NT-proBNP was 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). Higher NT-proBNP cut-offs increased 1-year composite CV proportions but excluded more patients. For example, In HFrEF outpatients, the 1-year proportion rose from 22.0% (no cut-off) to 24.3% at ≥600 pg/mL and 26.2% at ≥1,200 pg/mL, a 19% (95% CI:14.0-24.4) relative increase. Screening failure rose from 16.0% to 26.4% at these respective cut-offs. Optimal prognostic thresholds aligned with or exceeded subgroup median NT-proBNP values. 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.

Auteurs: Megan Schroeder, Lars H Lund, Christoph Gerlinger, Yvonne Mei Fong Lim, Stefan Koudstaal, Ulf Dahlström, Gianluigi Savarese

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Bron: ESC heart failure, https://doi.org/10.1093/eschf/xvag089. Bijgewerkt 2026-07-03T18:39:21Z. 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.