Biomarkers in outpatient heart failure management; Are they correlated to and do they influence clinical judgment?

Peeters, J.M.; Wijk, Sandra Sanders‐van; Bektas, S.; Knackstedt, Christian; Rickenbacher, Peter; Nietlispach, Fabiàn; Handschin, Rolf; Maeder, Micha T.; Muzzarelli, Stefano; Pfisterer, Matthias; Rocca, Hans‐Peter Brunner‐La

doi:10.1007/s12471-013-0503-y

Cited by 7 publications

(6 citation statements)

References 26 publications

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“…Six studies (Felker 2014; Jourdain 2014; Metra 2012; Moe 2007; Saraya 2015; Steinen 2014) are classified as ongoing. Of these, four studies (Felker 2014; Jourdain 2014; Moe 2007; Steinen 2014) are currently recruiting or have just finished recruiting.…”

Section: Resultsmentioning

confidence: 99%

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B-type natriuretic peptide-guided treatment for heart failure

McLellan

Heneghan

Perera

et al. 2016

Cochrane Database of Systematic Reviews

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Background Heart failure is a condition in which the heart does not pump enough blood to meet all the needs of the body. Symptoms of heart failure include breathlessness, fatigue and fluid retention. Outcomes for patients with heart failure are highly variable; however on average, these patients have a poor prognosis. Prognosis can be improved with early diagnosis and appropriate use of medical treatment, use of devices and transplantation. Patients with heart failure are high users of healthcare resources, not only due to drug and device treatments, but due to high costs of hospitalisation care. B‐type natriuretic peptide levels are already used as biomarkers for diagnosis and prognosis of heart failure, but could offer to clinicians a possible tool to guide drug treatment. This could optimise drug management in heart failure patients whilst allaying concerns over potential side effects due to drug intolerance. Objectives To assess whether treatment guided by serial BNP or NT‐proBNP (collectively referred to as NP) monitoring improves outcomes compared with treatment guided by clinical assessment alone. Search methods Searches were conducted up to 15 March 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (OVID), Embase (OVID), the Database of Abstracts of Reviews of Effects (DARE) and the NHS Economic Evaluation Database in the Cochrane Library. Searches were also conducted in the Science Citation Index Expanded, the Conference Proceedings Citation Index on Web of Science (Thomson Reuters), World Health Organization International Clinical Trials Registry and ClinicalTrials.gov. We applied no date or language restrictions. Selection criteria We included randomised controlled trials of NP‐guided treatment of heart failure versus treatment guided by clinical assessment alone with no restriction on follow‐up. Adults treated for heart failure, in both in‐hospital and out‐of‐hospital settings, and trials reporting a clinical outcome were included. Data collection and analysis Two review authors independently selected studies for inclusion, extracted data and evaluated risk of bias. Risk ratios (RR) were calculated for dichotomous data, and pooled mean differences (MD) (with 95% confidence intervals (CI)) were calculated for continuous data. We contacted trial authors to obtain missing data. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, we assessed the quality of the evidence and GRADE profiler (GRADEPRO) was used to import data from Review Manager to create a 'Summary of findings' table. Main results We included 18 randomised controlled trials with 3660 participants (range of mean age: 57 to 80 years) comparing NP‐guided treatment with clinical assessment alone. The evidence for all‐cause mortality using NP‐guided treatment showed uncertainty (RR 0.87, 95% CI 0...

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Section: Resultsmentioning

confidence: 99%

“…Of these, four studies (Felker 2014; Jourdain 2014; Moe 2007; Steinen 2014) are currently recruiting or have just finished recruiting. Metra 2012 finished recruiting in August 2009 and is due to publish shortly.…”

Section: Resultsmentioning

confidence: 99%

B-type natriuretic peptide-guided treatment for heart failure

McLellan

Heneghan

Perera

et al. 2016

Cochrane Database of Systematic Reviews

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“…Their incremental ability was observed even after adjustment with several clinical covariates in multivariate analysis mirroring the ability of this set of biomarkers to accurately reflect several pathophysiological processes following MI [ 3 ]. A panel of biomarkers NTproBNP, hsTnT, cystatin-C, GDF-15 and CRP did not correlate with clinical signs and symptoms of NYHA class, oedema, rales, jugular venous distention and orthopnoea showing that the information provided by biomarkers is distinct to that available from clinical signs and symptoms, and their measurement would positively influence clinical judgement [ 33 ]. In addition to this, multi biomarker scores integrating biomarker information for efficient patient prognosis have been studied, demonstrating the practical applicability of the biomarker tests [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

GDF 15 - A Novel Biomarker in the Offing for Heart Failure

George¹,

Jena²,

Srivatsan³

et al. 2016

CCR

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Background:Several diagnostic and prognostic biomarkers are being explored in heart failure. GDF-15 belongs to the transforming growth factor β (TGF-β) cytokine family that is highly up regulated in inflammatory conditions. We undertook this systematic review to summarize the current evidence on the utility of GDF-15 as a biomarker in heart failure.Design and Methods:Multiple electronic databases for studies that reported the association between GDF- 15 and heart failure were searched using different electronic databases such as MEDLINE, Science Direct, Springer Link, Scopus, Cochrane Reviews, and Google Scholar using pre-defined inclusion- exclusion criteria.Results:Twenty one original studies were identified that included data from 20,920 study participants. GDF 15 was found to be a strong prognosticator of all-cause mortality in heart failure patients. Several studies found the benefit of using GDF-15 as a component of a multi-biomarker strategy in prognosticating patients with heart failure.Conclusion:More studies are warranted to elucidate the molecular pathways involving GDF-15 and to see how knowledge about GDF-15 can be used to make therapeutic decisions in the clinic.

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“…Natriuretic peptides are useful biomarkers with added diagnostic value on top of clinical assessment [ 7 ], although with much better negative predictive values (exclusion of HF) than positive predictive values (‘confirming’ HF) [ 4 ]. Importantly, however, in HFpEF natriuretic peptide levels can be at normal levels, especially in the early phases of the disease, when the patient has not exercised in the last couple of days, and in the absence of signs of water and salt retention.…”

Section: Women and Heart Failure With Preserved Ejection Fractionmentioning

confidence: 99%

Heart failure with preserved ejection fraction in women: the Dutch Queen of Hearts program

et al. 2015

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Heart failure (HF) poses a heavy burden on patients, their families and society. The syndrome of HF comes in two types: with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The latter is on the increase and predominantly present in women, especially the older ones. There is an urgent need for mortality-reducing drugs in HFpEF, a disease affecting around 5 % of those aged 65 years and over. HFpEF develops in patients with risk factors and comorbidities such as obesity, hypertension, diabetes, COPD, but also preeclampsia. These conditions are likely to drive microvascular disease with involvement of the coronary microvasculature, which may eventually evolve into HFpEF. Currently, the diagnosis of HFPEF relies mainly on echocardiography. There are no biomarkers that can help diagnose female microvascular disease or facilitate the diagnosis of (early stages of) HFpEF. Recently a Dutch consortium was initiated, Queen of Hearts, with support from the Netherlands Heart Foundation, with the aim to discover and validate biomarkers for diastolic dysfunction and HFpEF in women. These biomarkers come from innovative blood-derived sources such as extracellular vesicles and circulating cells. Within the Queen of Hearts consortium, we will pursue female biomarkers that have the potential for further evolution in assays with point of care capabilities. As a spin-off, the consortium will gain knowledge on gender-specific pathology of HFpEF, possibly opening up novel treatment options.

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Biomarkers in outpatient heart failure management; Are they correlated to and do they influence clinical judgment?

Cited by 7 publications

References 26 publications

B-type natriuretic peptide-guided treatment for heart failure

B-type natriuretic peptide-guided treatment for heart failure

GDF 15 - A Novel Biomarker in the Offing for Heart Failure

Heart failure with preserved ejection fraction in women: the Dutch Queen of Hearts program

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