{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T01:37:07Z","timestamp":1768786627169,"version":"3.49.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Therapy guided by N-terminal-pro-B-type natriuretic peptide (NT-proBNP) levels may improve outcomes in patients with chronic heart failure (HF), especially in younger patients with reduced left ventricular ejection fraction. It remains unclear whether treatment effects persist after discontinuation of the NT-proBNP\u2013guided treatment strategy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure randomized 499 patients with HF aged \u226560 years with left ventricular ejection fraction \u226445% to intensified, NT-proBNP\u2013guided versus standard, symptom-guided therapy into prespecified age groups (60\u201374 and \u226575 years) during 18 months. A total of 329 patients (92%) alive at 18 months agreed to long-term follow-up. HF medication was intensified to a larger extent in the NT-proBNP\u2013guided group. During long-term, NT-proBNP\u2013guided therapy did not improve hospital-free (primary end point: hazard ratio, 0.87; 95% confidence interval, 0.71\u20131.06;\n              <jats:italic>P<\/jats:italic>\n              =0.16) or overall survival (hazard ratio, 0.85; 95% confidence interval, 0.64\u20131.13;\n              <jats:italic>P<\/jats:italic>\n              =0.25) but did improve HF hospitalization-free survival (hazard ratio, 0.70; 95% confidence interval, 0.55\u20130.90;\n              <jats:italic>P<\/jats:italic>\n              =0.005). Patients aged 60 to 74 years had benefit from NT-proBNP\u2013guided therapy on the primary end point and HF hospitalization-free survival, whereas patients aged \u226575 years did not (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.10 for interaction). In landmark analysis, there was no regression to the mean after cessation of the NT-proBNP\u2013guided strategy. More intensified HF medication at month 12 was associated with better long-term HF hospitalization-free and overall survival.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Intensified, NT-proBNP\u2013guided therapy did not improve the primary end point compared with symptom-guided therapy but did improve HF hospitalization-free survival. Within the subgroup of patients aged 60 to 74 years, it improved clinical outcome including the primary end point. These effects did not disappear after cessation of the NT-proBNP\u2013guided strategy on the long-term. This is possibly attributable to a more intensified HF medical therapy in the NT-proBNP\u2013guided group.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.isrctn.org\">http:\/\/www.isrctn.org<\/jats:ext-link>\n              . Unique identifier: ISRCTN43596477.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.113.000527","type":"journal-article","created":{"date-parts":[[2013,12,19]],"date-time":"2013-12-19T07:26:23Z","timestamp":1387437983000},"page":"131-139","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Long-Term Results of Intensified, N-Terminal-Pro-B-Type Natriuretic Peptide\u2013Guided Versus Symptom-Guided Treatment in Elderly Patients With Heart Failure"],"prefix":"10.1161","volume":"7","author":[{"given":"Sandra","family":"Sanders-van Wijk","sequence":"first","affiliation":[{"name":"From the Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands (S.S.-v.W, H.-P.B.-L.R.); Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland (M.T.M., H.R.); Swiss Cardiovascular Centre, Department of Cardiology, Bern University Hospital, Bern, Switzerland (F.N.); Department of Internal Medicine, University Hospital Liestal, Liestal, Switzerland (W.E.); Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland (P.E...."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micha T.","family":"Maeder","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands (S.S.-v.W, H.-P.B.-L.R.); Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland (M.T.M., H.R.); Swiss Cardiovascular Centre, Department of Cardiology, Bern University Hospital, Bern, Switzerland (F.N.); Department of Internal Medicine, University Hospital Liestal, Liestal, Switzerland (W.E.); Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland (P.E...."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Nietlispach","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands (S.S.-v.W, H.-P.B.-L.R.); Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland (M.T.M., H.R.); Swiss Cardiovascular Centre, Department of Cardiology, Bern University Hospital, Bern, Switzerland (F.N.); Department of Internal Medicine, University Hospital Liestal, Liestal, Switzerland (W.E.); Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland (P.E...."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans","family":"Rickli","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands (S.S.-v.W, H.-P.B.-L.R.); Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland (M.T.M., H.R.); Swiss Cardiovascular Centre, Department of Cardiology, Bern University Hospital, Bern, Switzerland (F.N.); Department of Internal Medicine, University Hospital Liestal, Liestal, Switzerland (W.E.); Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland (P.E...."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Werner","family":"Estlinbaum","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands (S.S.-v.W, H.-P.B.-L.R.); 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