Quantifying the added value of BNP in suspected heart failure in general practice: an individual patient data meta-analysis

Kelder, Johannes C.; Cowie, Martin R.; McDonagh, Theresa A.; Hardman, S. M. C.; Grobbee, Diederick E.; Cost, Bernard; Hoes, Arno W.

doi:10.1136/hrt.2010.220426

Cited by 62 publications

(23 citation statements)

References 34 publications

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“…Em metanálise recentemente publicada, a adição da dosagem de BNP ao exame clínico aumentou a acurácia diagnóstica 19 . Portanto, nas situações de dúvida, o BNP pode ser utilizado, somado ao exame clínico.…”

Section: Bnp/ntprobnp (Tabela 1)unclassified

Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012

Bocchi

Marcondes‐Braga²,

Bacal³

et al. 2012

Arq. Bras. Cardiol.

221

206

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Esta atualização da Diretriz de Insuficiência Cardíaca Crônica (IC) - 2012 surge para reavaliar as recomendações através de uma avaliação criteriosa das pesquisas (considerando-se a qualidade dos estudos), fundamental para que se atinja esse propósito. Para tanto, foi dada ênfase ao efeito em desfechos de morte, à qualidade "CONSORT" (Consolidated Standards of Reporting Trials), à descrição qualitativa e quantitativa da otimização da medicação, à população realmente incluída, às metanálises somente de estudos qualidade "CONSORT", à custo-efetividade, à existência de efeito de classe, ao número de pacientes incluídos e à análise de subgrupos apenas para gerar hipóteses. Na área da epidemiologia, as recentes abordagens das características da IC com fração de ejeção preservada (ICFEP) e da importância da IC como causa de morte no Brasil foram revisadas. Além disso, este documento contempla a reavaliação do valor dos biomarcadores no diagnóstico e no seguimento da IC, o papel diagnóstico da angiotomografia coronariana nos casos de risco intermediário ou baixo risco de doença coronariana, a não recomendação de rotina do telemonitoramento; o surgimento da avaliação familiar como recomendação importante, e a reavaliação da restrição da adição de sal na dieta. As clínicas de IC e reabilitação física, apesar de alguns resultados negativos ou controversos quanto à mortalidade, continuam com recomendação importante. No campo do tratamento farmacológico, abrange-se a reavaliação da indicação do nebivolol, introduz-se a ivabradina como um novo paradigma no tratamento, os antagonistas da aldosterona não têm efeito de classe reconhecido, o ômega 3 passa a ser recomendado, o ferro administrado por via endovenosa e o sildenafil recebem indicação em casos selecionados. Todas as recomendações para outras etiologias são expandidas para a Doença de Chagas. Na área da anticoagulação, recomenda-se a utilização dos escores CHA2DS2VASC e o HAS-BLED na fibrilação atrial, com introdução de inibidores da trombina e do fator Xa como alternativas na anticoagulação. No tratamento cirúrgico da IC, considerou-se que resultados neutros do estudo STICH influenciaram as recomendações, o transplante cardíaco continua a ser o tratamento indicado nas fases evolutivas tardias de IC, os dispositivos de assistência circulatória mecânica para terapia de destino passam a ter recomendação, a duração do QRS foi fundamental na indicação de TRV-AV, e o CDI continua com recomendação I para miocardiopatia isquêmica. Entretanto, baseada em análise crítica dos estudos considerando-se o custo-efetividade, o CDI não atingiu recomendação I para classes menos graves devido as limitações dos estudos. Também a importância da cardiotoxicidade por drogas para tratamento de neoplasias foi ressaltada, o tratamento da IC na gravidez e da miocardite foi revisado. Novos potenciais métodos de tratamento em fase de pesquisa são apresentados e novos fluxogramas de diagnóstico e tratamento da IC, reformulados, foram incluído

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Section: Bnp/ntprobnp (Tabela 1)unclassified

Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012

Bocchi

Marcondes‐Braga²,

Bacal³

et al. 2012

Arq. Bras. Cardiol.

221

206

View full text Add to dashboard Cite

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“…These levels are greatly increased in patients with HF and they are strongly correlated with the severity of LV systolic and diastolic dysfunction [53, 55], as well as with the severity of HF, as assessed by the New York Heart Association (NYHA) classification [56, 57]. BNP and NT-pro-BNP are currently considered as useful biomarkers for the diagnosis and evaluation of HF in the general population [58, 59]. They also have an important prognostic value, as independent predictors of mortality and other cardiac endpoints in patients with HF [60].…”

Section: Diagnosismentioning

confidence: 99%

Heart Failure in Patients with Chronic Kidney Disease: A Systematic Integrative Review

Segall

Nistor

Covic

2014

BioMed Research International

130

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Introduction. Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and is strongly associated with mortality in these patients. However, the treatment of HF in this population is largely unclear. Study Design. We conducted a systematic integrative review of the literature to assess the current evidence of HF treatment in CKD patients, searching electronic databases in April 2014. Synthesis used narrative methods. Setting and Population. We focused on adults with a primary diagnosis of CKD and HF. Selection Criteria for Studies. We included studies of any design, quantitative or qualitative. Interventions. HF treatment was defined as any formal means taken to improve the symptoms of HF and/or the heart structure and function abnormalities. Outcomes. Measures of all kinds were considered of interest. Results. Of 1,439 results returned by database searches, 79 articles met inclusion criteria. A further 23 relevant articles were identified by hand searching. Conclusions. Control of fluid overload, the use of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and optimization of dialysis appear to be the most important methods to treat HF in CKD and ESRD patients. Aldosterone antagonists and digitalis glycosides may additionally be considered; however, their use is associated with significant risks. The role of anemia correction, control of CKD-mineral and bone disorder, and cardiac resynchronization therapy are also discussed.

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“…Of additional tests, natriuretic peptides are most informative and valuable. [18][19][20]23 High-risk patients (e.g. type 2 diabetes, COPD) may benefit from risk stratification based on B-type NPs and case finding.…”

Section: Moreover B-type Nps May Normalise In 24 Hours and Thus Bnp Andmentioning

confidence: 99%

What the General Practitioner Needs to Know About Their Chronic Heart Failure Patientt

Rutten

Gallagher

2016

Cardiac Failure Review

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Access at: www.CFRjournal.com "I cannot keep pace with my husband. Is it simply ageing, overweight and my sedentary lifestyle?" This is a common encounter in primary care, bearing in mind that around 16 % of older community-dwelling people experience at least grade 3 shortness of breath according to the Medical Research Council questionnaire ("walk slower than people of the same age because of breathlessness or have to stop for breath when walking at my own pace on the level"). 1Heart failure (HF) is a common syndrome, predominantly occurring in the elderly, with a significant impact on quality of life, high mortality rates and unplanned hospitalisations that place a significant burden on health care systems and budgets in developed countries.2 General practitioners (GPs) play an important role in the disease trajectory of a patient with HF. In particular, GPs have a pivotal role in the diagnostic and palliative phase, and participate in co-operative care with specialist teams in the intervening period.Three important reasons underlie the gradual shift from hospitalbased care to primary care being seen in many developed countries.First, in the last decade, heart failure with a preserved ejection fraction (HFpEF) is increasing, while the prevalence of heart failure with a reduced ejection fraction (HFrEF) is decreasing. For HFpEF, hospital care is in general not necessary, except in cases with acute exacerbations, and it is characterised by multiple comorbidities, which benefit from generalist care. A second reason is that governments are increasingly shifting chronic disease care to primary care, given international evidence on cost-effectiveness.Studies have shown that if HFrEF patients are adequately up-titrated, the care provided by GPs is as good as that of a HF clinic.3,4 A final reason is that risk stratification with natriuretic peptides and up-titration of cardiovascular (CV) drugs of high-risk people from the community, e.g. those with a previous coronary event, hypertension or type 2 diabetes, effectively reduces the development of HF and CV hospitalisations. Early initiation or up-titration of angiotensinconverting enzyme inhibitors (ACE-inhibitors), angiotensin receptor blockers (ARBs) and beta-blockers has been shown to be effective in this group. 5,6 GPs should be prepared for this transition in care. Here, the authors give a framework for the potential role of GP in HF care throughout the natural history of the condition (see Figure 1). Definition, Diagnosis, Case Finding and Risk StratificationA diagnosis of HF requires a combination of clinical features -such as breathlessness, fatigue and ankle oedema -together with a structural or functional abnormality of the heart that impairs its ability to pump or relax on echocardiography.2,7 Pump failure may be caused by reduced contraction of the left ventricle, measured as a reduced ejection fraction (EF; <40 %). Reduced EF is almost always accompanied by impaired filling of the left ventricle, but in some patients reduced filling dominates whereas the...

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Quantifying the added value of BNP in suspected heart failure in general practice: an individual patient data meta-analysis

Abstract: BNP has considerable diagnostic value in addition to signs and symptoms in patients suspected of heart failure in primary care. However, using BNP alone with the currently recommended cut-off levels is not sufficient to make a reliable diagnosis of heart failure.

Cited by 62 publications

References 34 publications

Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012

Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012

Heart Failure in Patients with Chronic Kidney Disease: A Systematic Integrative Review

What the General Practitioner Needs to Know About Their Chronic Heart Failure Patientt

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