Michael Felker, MD: The GUIDE-IT Trial

Michael Felker, MD: So GUIDE-IT is really based on this idea that you could utilize a blood test a biomarker, NT-proBNP, which is a peptide that circulates in the blood and it reflects heart layer severity and heart failure status. There's been a lot of small trials that have really tested this idea that you could use in NT-proBNP levels as a guide - hence the name [of the trial] - to figure out how to adjust chronic heart failure therapy. And this is something we do all the time in other diseases like hypertension. The idea with GUIDE-IT was, really, to try to prove that strategy where you utilize the blood test to get people on the best therapy, and have a goal of suppressing the blood test below a certain level, which in our study was 1000 for NT-proBNP, that that would give you better outcomes than just usual care.

We looked at how much the NT-proBNP levels went down or what medications were used or what the outcomes were, and the primary endpoint was the composite of cardiovascular death or heart failure hospitalization, so [they were] hard real outcomes. We saw that there was essentially no difference between those, which was surprising because we had anticipated, and the prior studies had suggested, that using this strategy of targeting the blood test would give you better results. So there's all been a lot of discussion and speculation about why the results turned out like they did.

The big message from GUIDE-IT, or a big message from GUIDE-IT, is that, regardless of which arm you ran patients on or who got treated more aggressively, when we were able to get their NT-proBNP levels down, the lower did better regardless of which treatment arm they were in. It just underscores the importance of sort of overcoming that therapeutic inertia that I described and to always be figuring out, "what can I do for this patient in this encounter today that's going to make an impact on their future and clinical course?" [It underscores the need for us to] not be satisfied with the status quo because it's very easy to say, "oh everything seems like it's kind of alright, let's not do anything," but that's not really the way to take the best care of our patients.