Natriuretic Peptide-Based Screening and Collaborative Care for Heart Failure The STOP-HF Randomized Trial
Natriuretic Peptide-Based Screening and Collaborative Care for Heart Failure The STOP-HF Randomized Trial
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DOI：
10.1001/jama.2013.7588
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发表时间：
2013-07-03
影响因子：
120.7
通讯作者：
McDonald, Kenneth
中科院分区：
文献类型：
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作者：
Ledwidge, Mark;Gallagher, Joseph;McDonald, Kenneth
重要性心力衰竭的预防策略是必要的。目的确定使用脑型利钠肽（BNP）和协作护理在高危人群中筛查项目在减少新诊断心力衰竭和显著左心室（LV）收缩和/或舒张功能障碍患病率方面的有效性。设计、设置和参与者圣文森特筛查预防心力衰竭研究，一项涉及1374名有心血管危险因素的受试者的平行组随机试验（平均年龄，64.8 [SD，10.2]岁），从2005年1月至2009年12月期间在爱尔兰的39个初级保健实践中招募，并随访至2011年12月干预患者被随机分配接受常规初级护理（对照组; n=677）或BNP检测筛查（n=697）。BNP水平为50 pg/mL或更高的干预组参与者进行了超声心动图和他们的初级保健医生和专科心血管service.Main结局和措施之间的协作护理的主要终点是无症状的左心室功能不全或新诊断的心力衰竭的患病率。次要终点包括因心律失常、短暂性脑缺血发作、中风、心肌梗死、外周或肺血栓/栓塞或心力衰竭而紧急住院治疗。结果干预组共有263例患者（41.6%）至少有1例BNP阅读值为50 pg/mL或更高。干预组进行了更多的心血管检查（对照组，496例/1000患者-年vs干预组，850例/1000患者-年;发病率比，1.71; 95%CI，1.61-1.83; P
IMPORTANCE Prevention strategies for heart failure are needed.OBJECTIVE To determine the efficacy of a screening program using brain-type natriuretic peptide (BNP) and collaborative care in an at-risk population in reducing newly diagnosed heart failure and prevalence of significant left ventricular (LV) systolic and/or diastolic dysfunction.DESIGN, SETTING, AND PARTICIPANTS The St Vincent's Screening to Prevent Heart Failure Study, a parallel-group randomized trial involving 1374 participants with cardiovascular risk factors (mean age, 64.8 [SD, 10.2] years) recruited from 39 primary care practices in Ireland between January 2005 and December 2009 and followed up until December 2011 (mean follow-up, 4.2 [SD, 1.2] years).INTERVENTION Patients were randomly assigned to receive usual primary care (control condition; n=677) or screening with BNP testing (n=697). Intervention-group participants with BNP levels of 50 pg/mL or higher underwent echocardiography and collaborative care between their primary care physician and specialist cardiovascular service.MAIN OUTCOMES AND MEASURES The primary end point was prevalence of asymptomatic LV dysfunction with or without newly diagnosed heart failure. Secondary end points included emergency hospitalization for arrhythmia, transient ischemic attack, stroke, myocardial infarction, peripheral or pulmonary thrombosis/embolus, or heart failure.RESULTS A total of 263 patients (41.6%) in the intervention group had at least 1 BNP reading of 50 pg/mL or higher. The intervention group underwent more cardiovascular investigations (control, 496 per 1000 patient-years vs intervention, 850 per 1000 patient-years; incidence rate ratio, 1.71; 95% CI, 1.61-1.83; P