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To the Editor: The randomized trial of BNP- vs symptom-guided therapy for heart failure by Dr Pfisterer and colleagues¹ raised interesting questions regarding application of evidence-based medications and professional guideline recommendations for heart failure across important high-risk groups such as older persons. Although their overall study of 499 patients did not show a benefit in BNP-guided strategy for outcomes, the authors suggested that the lack of statistical significance was due to lack of benefit in guideline-recommended therapies in patients older than 75 years old.

Although it is true that clinical trials have generally enrolled younger patients with fewer comorbidities, this does not mean that these therapies are not efficacious and effective in older patients with heart failure and reduced systolic function. There has been no significant heterogeneity in efficacy demonstrated for angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or β-blockers as a function of patient age.^2-3 Studies of clinical effectiveness . . . [Full Text of this Article]

Adrian F. Hernandez, MD, MHS
adrian.hernandez@duke.edu
Duke Clinical Research Institute
Durham, North Carolina

Gregg C. Fonarow, MD
Ahmanson–UCLA Cardiomyopathy Center
UCLA Medical Center
Los Angeles, California

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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
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BNP-Guided Heart Failure Therapy in Older Patients—Reply
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