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To the Editor: The report of the Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) by Dr Pfisterer and colleagues¹ showed similar efficacy of symptom-guided heart failure therapy compared with N-terminal brain natriuretic peptide (BNP)–guided therapy. Of 499 study participants, 104 (21%) had coexistent chronic obstructive pulmonary disease (COPD). However, the interaction between presence of COPD and mortality or hospital-free survival in this population was not described.

BNP-guided therapy with diuretics has been found to benefit patients with acute exacerbation of COPD.² The benefit has been attributed to lower right ventricular pressure due to diuretic therapy.² BNP is an effective screening test for the detection of cor pulmonale in patients with COPD.³

Patients with coexistent heart failure and COPD are expected to have increased right ventricular pressures, and the benefit of BNP-guided diuretic therapy or optimal heart failure therapy in this group is . . . [Full Text of this Article]

Emmanuel Bhaskar, MD
drmeb1974@yahoo.co.in
Department of Internal Medicine
Sri Ramachandra Medical College and Research Institute
Porur, Chennai, India

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RELATED ARTICLE

BNP-Guided vs Symptom-Guided Heart Failure Therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial
Matthias Pfisterer, Peter Buser, Hans Rickli, Marc Gutmann, Paul Erne, Peter Rickenbacher, André Vuillomenet, Urs Jeker, Paul Dubach, Hansjürg Beer, Se-Il Yoon, Thomas Suter, Hans H. Osterhues, Michael M. Schieber, Patrick Hilti, Ruth Schindler, Hans-Peter Brunner-La Rocca, and for the TIME-CHF Investigators
JAMA. 2009;301(4):383-392.
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BNP-Guided Heart Failure Therapy in Older Patients
Adrian F. Hernandez and Gregg C. Fonarow
JAMA. 2009;301(20):2091-2092.
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BNP-Guided Heart Failure Therapy in Older Patients—Reply
Hans-Peter Brunner La Rocca, Peter Buser, and Matthias Pfisterer
JAMA. 2009;301(20):2092-2093.
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