Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group. Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36; 26 males, 10 females, mean age: 81.9 years) or control group (n = 36; 25 males, 11 females, mean age: 76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074); NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

Congenital heart disease (CHDs)-whether it is associated with pulmonary hypertension (PH) or not-is the most common malformation in children. It is an important cause of infant mortality, long term morbidity and disability. Aim of the study is to assess the role of some genetic and environmental risk factors in patients with CHDs associated with PH. Subjects and methods: A case-control study was conducted and included 3 groups of cases; 37 patients with CHDs associated with PH, 37 patients with CHDs and 37 children without any congenital malformations were taken as a control group. The following clinical information was collected through predesigned questionnaires: maternal age at conception; parental consanguinity; maternal gestational diabetes (DM) and hypertension, adverse reproductive history (abortions and still births); and maternal environmental tobacco smoking (ETS) and deficient folic acid intake during pregnancy. Cytogenetic study for patients in the first and second groups of cases was carried out. Results: Chromosomal abnormalities were detected in 13.5% of patients with CHDs associated with PH and 10.8% of patients with CHDs. Maternal age, adverse reproductive history, maternal gestational DM and hypertension were not found to be significantly associated with congenital heart diseases in this study, while parental consanguinity, low maternal education level,