Biomarker-Guided Risk Management for Secondary Prevention following Acute Coronary Syndromes: a Feasibility Study

Background. Recurrent clinical events remain common among patients following acute coronary syndromes and there is thus a need to improve secondary prevention to reduce clinical outcomes. Brain natriuretic peptide (NT-proBNP) is a predictor of outcome, independent of standard clinical risk factors, in patients with established cardiovascular disease. Initial studies suggest the potential for intensified renin-angiotensin antagonist/beta-blocker therapy in patients with elevated NT-proBNP to improve clinical outcomes in patients with cardiovascular disease. Aim. The aim of this is to develop the infrastructure to support a sustainable process to deliver a large-scale randomised controlled trial in primary care of a biomarker guided approach for long-term secondary prevention for people following hospitalisation for acute coronary syndromes in NZ. Methods. This feasibility study will assess a number of key pathways that need to be established and tested to ensure a large scale randomised controlled trial can be successfully implemented in the NZ healthcare setting. The study will include 100 patients with recent ACS, randomised 2:1 to NT-proBNP and usual care groups. The study primary end point will be the proportion of patients achieving the maximum tolerated medications and secondary end-points will include assessment of the number of clinic visits required to titrate the medications following randomisation and qualitative assessment of the methods for enrolment of the patients for this study.