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.
Hernandez AF, Fonarow GC. BNP-Guided Heart Failure Therapy in Older Patients. JAMA. 2009;301(20):2091-2093. doi:10.1001/jama.2009.694