Natriuretic peptide-guided treatment for heart failure: A systematic review and meta-analysis

Julie McLellan, Clare R. Bankhead*, Jason L. Oke, F. D.Richard Hobbs, Clare J. Taylor, Rafael Perera

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Background GUIDE-IT, the largest trial to date, published in August 2017, evaluating the effectiveness of natriuretic peptide (NP)-guided treatment of heart failure (HF), was stopped early for futility on a composite outcome. However, the reported effect sizes on individual outcomes of all-cause mortality and HF admissions are potentially clinically relevant. Objective This systematic review and meta-analysis aims to combine all available trial level evidence to determine if NP-guided treatment of HF reduces all-cause mortality and HF admissions in patients with HF. Study selection Eight databases, no language restrictions, up to November 2017 were searched for all randomised controlled trials comparing NP-guided treatment versus clinical assessment alone in adult patients with HF. No language restrictions were applied. Publications were independently double screened and extracted. Fixed-effect meta-analyses were conducted. Findings 89 papers were included, reporting 19 trials (4554 participants), average ages 62-80 years. Pooled risk ratio estimates for all-cause mortality (16 trials, 4063 participants) were 0.87, 95% CI 0.77 to 0.99 and 0.80, 95% CI 0.72 to 0.89 for HF admissions (11 trials, 2822 participants). Sensitivity analyses, restricted to low risk of bias, produced similar estimates, but were no longer statistically significant. Conclusions Considering all the evidence to date, the pooled effects suggest that NP-guided treatment is beneficial in reducing HF admissions and all-cause mortality. However, there is still insufficient high-quality evidence to make definitive recommendations on the use of NP-guided treatment in clinical practice. Trial registration number Systematic Review Cochrane Database Number: CD008966.

Original languageEnglish
Pages (from-to)33-37
Number of pages5
JournalBMJ evidence-based medicine
Volume25
Issue number1
DOIs
Publication statusPublished - 1 Feb 2020

Bibliographical note

Funding Information:
Funding This work was supported by funds for independent

Publisher Copyright:
� Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords

  • all-cause mortality
  • biomarker
  • heart failure
  • heart failure admission
  • meta-analysis
  • natriuretic peptide

ASJC Scopus subject areas

  • General Medicine

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