Heart failure with reduced ejection fraction (HFrFE) is associated with a high morbidity and mortality. His care has seen a lot of progress in recent years. Good practice guidelines have been established but, unfortunately, insufficiently applied in clinical practice and therapeutic goals are often not achieved. Some randomized trials have suggested that BNP or Nt-proBNP is useful in this follow-up, but the evidence is not established.

The purpose of our study is that a biomarker-guided therapy of HFrFE would reduce cardiovascular events compared to a therapeutic strategy based solely on clinical judgment, over a period of follow-up of 1 year in patients with HfrEF.

We performed a prospective randomized, unblinded, therapeutic follow-up study. Patients were randomized into two arms: conventional follow-up with treatment optimization according to international guidelines and arm followed by Nt-proBNP with an additional objective, that of reaching a level of Nt-proBNP ≤1000pg/ml.

252 patients were enrolled, the average age is 59 years. The ischemic etiology is the most predominant, the mean FE was ≈30%.

At the end of the follow-up, the main endpoint (CV death, CV hospitalization, worsening of HF) occurred in 41.13% of the BNP group and 44.53% of the classic follow-up group with a total of 240 recorded events (115 in the BNP group) and 125 in the 2nd group (P=0.585). The 12-month CV mortality rate in the BNP group is 14.5% and 17.2% in the SOC group (P=0.562). The number of hospitalizations for cardiovascular causes is 21.77% in the BNP group and 24.21% in the 2nd group (P=0.873).

In patients with HfrEF, NT-proBNP-guided therapy strategy was no more effective than a standard care strategy for improving morbidity and mortality.