Does B-type natriuretic peptide-guided therapy improve outcomes in patients with chronic heart failure? A systematic review and meta-analysis of randomized controlled trials

Abstract

The role of B-type natriuretic peptide (BNP) in the management of patients with chronic heart failure (CHF) was uncertain. The aim of this meta-analysis was to comprehensively evaluate the effect of BNP-guided therapy in CHF. Relevant randomized controlled trials were identified by searching of Pubmed, Embase and the Cochrane Library databases. Fixed or randomized effect models were applied to combine the data according to the heterogeneity of the included studies. Fourteen studies with 3,004 CHF patients were included. Results of our meta-analyses suggested that compared with clinical group, BNP-guided treatment significantly decreased the risk of heart failure-related hospitalization (RR 0.79, 95 % CI 0.63-0.98, p = 0.03), although did not significantly affect the risk of all-cause mortality (RR 0.94, 95 % CI 0.81-1.08, p = 0.39) or all-cause hospitalization (RR 0.97, 95 % CI 0.89-1.07, p = 0.56). Furthermore, between-group BNP changes seemed to be a significant modifier to the effects of BNP-guided therapy on clinical outcomes, and BNP-guided therapy may improve the clinical outcomes of CHF patients if substantial reduction of BNP can be achieved. In addition, BNP-guided therapy was not associated with increased risk for serious adverse events. BNP-guided therapy may improve the clinical outcomes of CHF patients if substantial reduction of BNP can be achieved. BNP-guided therapy seemed to be safe and promising for CHF patients, and future studies with well-designed BNP-guided medication up-titration strategies are needed to confirm these results.

Catheter ablation versus medical rate control for persistent atrial fibrillation in patients with heart failure

“…BNP and NT-proBNP have been further examined and determined to have diagnostic and prognostic value for HF, and therapy guided by BNP may improve HF outcomes. [23] As the number of studies were limited, the explanation for this result may be underpowered. Additional studies are needed to further explain the roles of BNP and NT-proBNP in AF and HF patients.…”

Brain natriuretic peptide usefulness in very elderly dyspnoeic patients: the BED study

“…Others studies suggest that in contrast to younger patients NPs are not useful for optimizing HF treatment after 75 years of age.…”

Head-to-head comparison of 10 natriuretic peptide assays

“…Several randomised studies and a meta-analysis have led to recommendations for chronic HF treatment guidance and monitoring according to NP values in addition to established clinical methods [39][40][41][42][43][44][45]. Although further larger studies are required to confirm our findings, the inter-technique variability shows that the definition of a peptide target for biomarker guidance is not yet achieved.…”