EFFECT OF A REGIMEN OF OPTIMAL MEDICAL THERAPY ON BRAIN NATRIURETIC PEPTIDE (BNP) LEVELS IN HEART FAILURE IN THE PAKISTANI POPULATION

Abstract

Objective: To document the effect of optimal medical therapy (OMT) on BNP
levels in heart failure in Pakistani population.
Methodology: In this Quasi experimental study, 75 consecutive stage C heart
failure patients that had not been on OMT were included. These patients had been
referred to AFIC-NIHD Heart Transplantation Department for assessment
regarding heart transplantation. Initial assessments were carried out in hospital.
Patients who were on OMT already were excluded. The prescription (carvedilol,
lisinopril, spironolactone) was introduced as in patient as per pre defined protocol
after clinical, imaging and lab evaluation. The patients were followed up in clinic
and the dose escalation was done at regular intervals in out patients department.
Clinical and lab variables were collected included BNP levels before starting
treatment and 4 weeks after treatment.
Results : Males were 75% and females were 25%. Mean age was 38.69±12.98
years (range 18-70 years). Mean Ejection fraction was 23.9% (range 15 – 34%).
At one month clinical status of all patients improved except one. The patients had
improved from NYHA class-III to NYHA class-II of dyspnoea. The mean baseline
BNP level was 1331 pg/ mL, and the BNP level 4 weeks after the OMT trial was
951.9 pg/mL. This reduction was statistically significant (p=0.016).
Conclusion: OMT improves the BNP levels within a span of one month in patients
with advanced systolic heart failure. This also correlated with the clinical
improvement in the patients, and it was observed that BNP levels helped to
monitor patients objectively and adjust OMT.