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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 . 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 .
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Intervention_Other
Intensified vs Standard Medical Therapy
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Intervention_Other
symptom-guided therapy
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Intervention_Other
BNP-guided therapy
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Outcome_Mortality
18-month survival free of all-cause hospitalizations and quality of life as assessed by structured validated questionnaires .
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Outcome_Mortality
survival free of all-cause hospitalizations
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Outcome_Other
Patients ' quality-of-life metrics
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Outcome_Mortality
survival free of hospitalization for heart failure
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Outcome_Other
quality of life