NT-proBNP and Clinical Outcomes in Patients With HFrEF According to Atrial Fibrillation: Insights From QUEST.
Abstract
Background
The Chinese traditional medicine qiliqiangxin (QLQX) improves outcomes in patients with heart failure with reduced ejection fraction (HFrEF) when added to guideline-directed medical therapy.
Objectives
This post hoc analysis of the QUEST (Qiliqiangxin in Heart Failure: Assessment of Reduction in Mortality) trial assessed the efficacy and safety of QLQX according to baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and examined whether the prognostic value of baseline NT-proBNP varied by atrial fibrillation (AF) status.
Methods
QUEST enrolled 3,110 patients with HFrEF and NT-proBNP ≥450 pg/mL, and followed them for a median of 18 months. The primary outcome was cardiovascular (CV) death or heart failure (HF) hospitalization. NT-proBNP was analyzed by quartiles and as a continuous variable.
Results
Median baseline NT-proBNP was 1,731 pg/mL. Higher baseline NT-proBNP independently predicted greater risk of the primary outcome (adjusted HR for Q4 vs Q1: 4.03 [95% CI: 3.12-5.20]). The prognostic value of baseline NT-proBNP for all outcomes was consistent irrespective of AF status. At 3 months, QLQX reduced NT-proBNP by 10% compared with placebo. The HRs for the primary composite with QLQX vs placebo were 1.13 (95% CI: 0.73-1.76), 0.76 (95% CI: 0.54-1.06), 0.73 (95% CI: 0.55-0.95), and 0.75 (95% CI: 0.59-0.95) from the lowest to the highest NT-proBNP quartiles, respectively (Pinteraction = 0.48). Results were consistent for CV death, HF hospitalization, and total HF hospitalizations, and when NT-proBNP was modeled continuously (all Pinteraction ≥ 0.30).
Conclusions
The treatment effect of QLQX on CV events was consistent across the spectrum of baseline NT-proBNP in HFrEF. Baseline NT-proBNP strongly predicted the risk of CV outcomes and mortality, irrespective of AF status. (Qiliqiangxin in Heart Failure: Assessment of Reduction in Mortality [QUEST]; ChiCTR1900021929).