What is the “Peptide for Life” initiative? Who are the key stakeholders in this initiative?
The Peptide for Life initiative is a call for action to provide equal access to the use of natriuretic peptides in the diagnosis of acute heart failure across Europe.
With consistent scientific evidence and the highest recommendations from clinical guidelines, we felt it was a time to build strategies to help identify specific barriers to guideline implementation and to define actions to ensure that the majority of patients with acute dyspnea have access to natriuretic peptide measurements in the emergency department. It is well known that a timely and accurate diagnosis is crucial to enable the early initiation of key life-saving strategies. So, natriuretic peptides should allow clinicians to choose the best diagnostic and treatment strategy more rapidly and to triage patients more confidently.
In terms of stakeholders, the main stakeholders of this initiative are the European Society of Cardiology, the Heart Failure Association, the National Heart failure societies, in vitro diagnostic companies and obviously doctors and patients.
Why was this initiative undertaken? What are the gaps you are trying to address?
The setting of acute heart failure diagnosis is where the scientific evidence for the use of natriuretic peptides is most robust. Indeed, the use of natriuretic peptides is now embedded as class I, level of evidence A recommendation (Class I A) in the ESC and the American College of Cardiology/American Heart Association Clinical Practice Guidelines indication, which is the highest recommendation in international guidelines.
Nevertheless, the recently published Heart Failure Association (HFA) atlas showed a very uneven uptake of natriuretic peptides use in the emergency departments across Europe. The HFA atlas identified a median of 3.858 hospitals offering natriuretic peptides measurement in the emergency department per million people. Remarkably, however, none of the ESC countries reported access to natriuretic peptides testing in all its emergency departments. So, what we found was that the highest numbers were reported in Germany with 19.82 hospitals per million people with natriuretic peptide use in the emergency department, together with central Europe and Scandinavia. The countries with the lower use in emergency requirements per million people were Kyrgyzstan and North Macedonia with none, followed by the Russian Federation with 0.02 hospitals per million people using natriuretic peptides in emergency departments. These similarly low numbers were found in other countries from the former Soviet Union and Southeast Europe.
So, the Peptide for Life initiative is intended to increase the numbers in countries where natriuretic peptides are more underrepresented.
How can this initiative benefit acute heart failure patients?
This is a very important question because there is evidence that an NT-proBNP supportive strategy for patients attending the emergency department with dyspnoea leads to 14.5% fewer initial hospitalization, 16% fewer admissions to cardiology, 12.5% fewer admissions to intensive care units, 3.2% fewer emergency department readmissions and 21.6% fewer hospital readmissions.
Contemporary data also show that the use of natriuretic peptides and particularly NT-proBNP decreases average inpatient management costs by 10.3% and reduces the total length of stay in the emergency department and the hospital.
So, in some cases, the use of BNP or NT-proBNP as an aid in the diagnosis of acute heart failure in the emergency department can save lives, time, and money and this is what we want for our patients.
How do you envision this initiative can be driven and implemented (who should be the stakeholders responsible for its implementation) locally? What is the call to action for this initiative?
Implementation of this initiative is going to be probably arranged at the local level and by country and site coordinators.
We think that initially country and site coordinators together with the HFA and the National Heart failure societies will conduct educational activities and clinical case mentoring with follow-up surveillance to identify good clinical practices. For example, we are envisioning, at the first stage, one to three sites per country will be included to participate, with online webinars that will provide a theoretical background, clinical case discussion and direct mentoring on specific case scenarios. This will be taken for three to six months between country and site coordinators as well as experts in natriuretic peptides. This may be experts from the biomarkers working group of the heart failure association or elsewhere from the same country or the same area.
The first experience was conducted in 2021, in Southeast European countries particularly Syria, Croatia, Bosnia, Herzegovina, North Macedonia, Montenegro and Slovenia. But we know that there is a lot of interest already by the UK, there’s also interest in Spain and looks like there are all the countries including Asia that are interested in running their local Peptide for Life initiative. So, we envision that the Peptide for Life initiative should spread like an oil slick in areas of the world where the uptake of natriuretic peptides is lower.
Why is the initiative called “Peptide for Life”?
The “Peptide for Life” logo is coming in an attempt to mimic the “Stent for Life Initiative” launched by the European Society of Cardiology twenty years ago. The “Stent for Life Initiative” was launched because the uptake of stenting in the care of acute MI was too slow and so they developed this initiative, which helped to create national and regional networks for the treatment of STEMI.
We thought that putting a catchy name with a particular brand and logo was going to be easier to implement. In this way, we think that people may remember that peptide use saves lives. So that’s the exact meaning of the name.