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

Journal article

Background: GUIDE-IT, the largest trial to date, published in August 2017, evaluating the effectiveness of natriuretic peptide-guided treatment of heart failure, was stopped early for futility on a composite outcome. However, the reported effect sizes on individual outcomes of all-cause mortality and heart failure admissions are potentially clinically relevant.

Objective: This systematic review and meta-analysis aims to combine all available trial level evidence to determine if natriuretic peptide-guided treatment of heart failure reduces all-cause mortality and heart failure admissions in patients with heart failure.

Study selection: Eight databases, no language restrictions, to November 2017 were searched for all randomised controlled trials comparing natriuretic peptide-guided treatment versus clinical assessment alone in adult patients with heart failure. 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% confidence interval 0.77 to 0.99, and 0.80, 95% CI 0.72 to 0.89, for heart failure 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 heart failure admissions and all-cause mortality. However, there is still insufficient high quality evidence to make definitive recommendations on the use of natriuretic peptide-guided treatment in clinical practice.

Authors: McLellan, J; Bankhead, C; Oke, J; Hobbs, R; Taylor, C

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ
• Journal: BMJ Evidence Based Medicine
• Volume: 25
• Issue: 1
• Pages: 33-37
• Publication date: 2019-07-20
• Acceptance date: 2019-07-08
• DOI: 10.1136/bmjebm-2019-111208
• ISSN: 2515-446X
• Language: English
• Keywords: meta-analysis; heart failure admission; biomarker; all-cause mortality; heart failure; natriuretic peptide