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BNP-Guided Heart Failure Therapy in Older Patients—Reply
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In Reply: We agree with Dr Bhaskar that patients with heart failure should not be denied proven therapy based on symptoms even in presence of concomitant COPD. Thus, in TIME-CHF 313 of 322 patients (97%) without COPD and 78 of 83 (94%) with COPD were prescribed β-blockers after 6 months (P = .18) without differences in dosage. However, patients with severe COPD were excluded from the trial. To ensure that dyspnea at inclusion was in fact due to heart failure, a history of heart failure within the last year was required in all patients. BNP values at baseline were used to identify patients with cardiac reasons for dyspnea, not to further distinguish causes of heart failure, particularly right heart failure or COPD. In subgroup analyses, there was no interaction of COPD with the 2 treatment strategies relative to outcome (eg, P = .32 for the primary end point). But the point . . . [Full Text of this Article]
Hans-Peter Brunner La Rocca, MD;
Peter Buser, MD;
Matthias Pfisterer, MD
pfisterer@email.ch
Division of Cardiology
University Hospital Basel
Basel, Switzerland
for the TIME-CHF Investigators
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BNP-Guided Heart Failure Therapy in Older Patients
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