Improve management of acute heart failure with ProcAlCiTonin in EUrope

• Verfasst von: Möckel, Martin [VerfasserIn]
• Verfasst von: de Boer, Rudolf A. [VerfasserIn]
• Verfasst von: Slagman, Anna Christine [VerfasserIn]
• Verfasst von: Haehling, Stephan von [VerfasserIn]
• Verfasst von: Schou, Morten [VerfasserIn]
• Verfasst von: Vollert, Jörn Ole [VerfasserIn]
• Verfasst von: Wiemer, Jan C. [VerfasserIn]
• Verfasst von: Ebmeyer, Stefan [VerfasserIn]
• Verfasst von: Martín-Sánchez, F. Javier [VerfasserIn]
• Verfasst von: Maisel, Alan S. [VerfasserIn]
• Verfasst von: Giannitsis, Evangelos [VerfasserIn]
• Titel: Improve management of acute heart failure with ProcAlCiTonin in EUrope
• Titelzusatz: results of the randomized clinical trial IMPACT EU Biomarkers in Cardiology (BIC) 18
• Verf.angabe: Martin Möckel, Rudolf A. de Boer, Anna Christine Slagman, Stephan von Haehling, Morten Schou, Jörn Ole Vollert, Jan C. Wiemer, Stefan Ebmeyer, F. Javier Martín-Sánchez, Alan S. Maisel, and Evangelos Giannitsis
• E-Jahr: 2020
• Jahr: 12 December 2019
• Jahr des Originals: 2019
• Umfang: 9 S.
• Fussnoten: Gesehen am 29.10.2020
• Titel Quelle: Enthalten in: European journal of heart failure
• Ort Quelle: Oxford : Wiley, 1999
• Jahr Quelle: 2020
• Band/Heft Quelle: 22(2020), 2, Seite 267-275
• ISSN Quelle: 1879-0844
• DOI: doi:10.1002/ejhf.1667
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Acute heart failure
• Sach-SW: Antibiotic therapy
• Sach-SW: Mortality
• Sach-SW: Natriuretic peptides
• Sach-SW: Procalcitonin
• K10plus-PPN: 1737357364

Abstract

AIM: To determine whether initiation of antibiotic therapy (ABX) by procalcitonin (PCT) within 8 h of admission in patients presenting to the emergency department with symptoms and signs of acute heart failure (AHF) and elevated natriuretic peptides would improve clinical outcomes. METHODS AND RESULTS: The study was a randomized multicentre clinical trial conducted at 16 sites in Europe. Patients were randomized to either a PCT-guided strategy or standard care. Patients with PCT-guided strategy (n = 370) had ABX initiated if PCT was > 0.2 μg/L. Patients with standard care (n = 372) had AHF care in accordance with published guidelines without PCT. The primary endpoint was 90-day all-cause mortality. Pre-specified secondary endpoints included 30-day all-cause mortality and readmission and rate of pneumonia. The Data Safety and Review Committee recommended stopping the study for futility when 762 of the planned 792 patients had been enrolled. A total of 742 patients could be analysed. Patients were elderly (median age: 77 years), 38% were women, and had typical signs and symptoms of AHF. All-cause mortality at 90 days was 10.3% in the PCT-guided group vs. 8.2% in standard care (P = 0.316). Thirty-day readmission was significantly higher in the PCT-guided group vs. standard care but the difference vanished until day 90. The rate of pneumonia was overall low (7.5%) and not different between groups. CONCLUSIONS: In patients with AHF, a strategy of PCT-guided initiation of ABX was not more effective than a standard care strategy in improving clinical outcomes.