B-type natriuretic peptide-guided therapy for heart failure (HF): a systematic review and meta-analysis of individual participant data (IPD) and aggregate data

Abstract

BackgroundWe estimated the effectiveness of serial B-type natriuretic peptide (BNP) blood testing to guide up-titration of medication compared with symptom-guided up-titration of medication in patients with heart failure (HF).MethodsSystematic review and meta-analysis of randomised controlled trials (RCTs). We searched: MEDLINE (Ovid) 1950 to 9/06/2016; Embase (Ovid), 1980 to 2016 week 23; the Cochrane Library; ISI Web of Science (Citations Index and Conference Proceedings). The primary outcome was all-cause mortality; secondary outcomes were death related to HF, cardiovascular death, all-cause hospital admission, hospital admission for HF, adverse events, and quality of life. IPD were sought from all RCTs identified. Random-effects meta-analyses (two-stage) were used to estimate hazard ratios (HR) and confidence intervals (CIs) across RCTs, including HR estimates from published reports of studies that did not provide IPD. We estimated treatment-by-covariate interactions for age, gender, New York Heart Association (NYHA) class, HF type; diabetes status and baseline BNP subgroups. Dichotomous outcomes were analysed using random-effects odds ratio (OR) with 95% CI.ResultsWe identified 14 eligible RCTs, five providing IPD. BNP-guided therapy reduced the hazard of hospital admission for HF by 19% (13 RCTs, HR 0.81, 95% CI 0.68 to 0.98) but not all-cause mortality (13 RCTs; HR 0.87, 95% CI 0.75 to 1.01) or cardiovascular mortality (5 RCTs; OR 0.88, 95% CI 0.67 to 1.16). For all-cause mortality, there was a significant interaction between treatment strategy and age (p = 0.034, 11 RCTs; HR 0.70, 95% CI 0.53–0.92, patients < 75 years old and HR 1.07, 95% CI 0.84–1.37, patients ≥ 75 years old); ejection fraction (p = 0.026, 11 RCTs; HR 0.84, 95% CI 0.71–0.99, patients with heart failure with reduced ejection fraction (HFrEF); and HR 1.33, 95% CI 0.83–2.11, patients with heart failure with preserved ejection fraction (HFpEF)). Adverse events were significantly more frequent with BNP-guided therapy vs. symptom-guided therapy (5 RCTs; OR 1.29, 95% CI 1.04 to 1.60).ConclusionBNP-guided therapy did not reduce mortality but reduced HF hospitalisation. The overall quality of the evidence varied from low to very low. The relevance of these findings to unselected patients, particularly those managed by community generalists, are unclear.Systematic review registrationPROSPERO CRD42013005335Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0776-8) contains supplementary material, which is available to authorized users.

Prognostic significance of red cell distribution width in hospitalized older patients with heart failure or infection

“…Inclusion criteria of the patients with HF (group A) were: (i) age ≥75 years; (ii) HF fulfilled with the Framingham criteria; (iii) New York Heart Association classes III or IV; and (iv) plasma concentration of brain natriuretic peptide (BNP) ≥100 pg/mL with or without ongoing medication for HF. Plasma BNP level is used widely for the diagnosis, the evaluation of severity and the therapeutic guidance of HF . Patients in group A were subdivided from the viewpoint of severity.…”

“…Plasma BNP level is used widely for the diagnosis, the evaluation of severity and the therapeutic guidance of HF. 11,12 Patients in group A were subdivided from the viewpoint of severity.…”

Heart-Type Fatty Acid-Binding Protein (H-FABP) and Its Role as a Biomarker in Heart Failure: What Do We Know So Far?

“…According to the European Society of Cardiology (ESC) guidelines, HF is a syndrome characterised by typical symptoms and clinical signs, with a "structural and/or functional cardiac abnormality" as an underlying cause, "resulting in reduced cardiac output and/or elevated intra-cardiac pressures at rest or during stress" [46]. Due to their strong negative-predictive value, the use of natriuretic peptides is well-established in standard HF algorithms [46][47][48]. Nevertheless, like many other biomarkers, including cardiac troponins, elevated levels of B-type natriuretic peptide (BNP) may also indicate alternative conditions and BNP release may lag in conditions with very acute onset, such as flash pulmonary edema or right-sided acute HF (AHF) [46,49].…”

Натрийуретические Пептиды И Растворимый ST2-рецептор: Роль В Диагностике, Стратификации Риска И Лечении Больных С Хронической Сердечной Недостаточностью

“…Результаты большинства метаанализов показали, что лечение под контролем НУП ассоциировалось со снижением смертности [70][71][72][73][74][75][76][77][78][79]. Интересно, что снижение относительного риска смерти пациентов по любой причине отсутствовало в исследованиях с мониторированием BNP (р=0,37) и достигало 28% (р=0,007) в исследованиях с использованием NT-proBNP [74].…”

“…Примечательно, что у пациентов со сниженной ФВ в отличие от больных ХСНсФВ такие заболевания, как почечная недостаточность и артериальная гипертония, не влияли на эффективность НУП-управляемой терапии. В то же время у больных с сохранной ФВ без артериальной гипертонии в отличие от пациентов с повышенным артериальным давлением более эффективным было стандартное лечение (р=0,02) [79].…”