I read with interest the meta-analysis by Porapakkham et al1 concerning BNP-guided heart failure therapy. The authors correctly point out the need to assess the impact of this approach on HF hospitalization with the expectation of improvement in this outcome. However, considering the high prevalence of comorbodities and the likelihood of over diuresis, deterioration of renal function, and symptomatic hypotension, particularly in older patients, it should be kept in mind that intensification of therapy may paradoxically increase hospitalization. If these hospitalizations are not captured as HF hospitalization, the potential beneficial impact of BNP-guided heart failure therapy on HF hospitalizations may be overestimated. Therefore, in addition to non-HF events, the authors need to consider increasing HF hospitalization resulting from intensification of HF therapy as a potential contributor to the lack of reduction of all-cause hospitalization.
Ghali JK. The Challenges of Properly Identifying the Cause of Heart Failure Hospitalization. Arch Intern Med. 2010;170(14):1274-1275. doi:10.1001/archinternmed.2010.231