The quality of evidence is downgraded by study limitations (lack of blinding) and by inconsistency (variability in results).
A Cochrane review [Abstract] 1 included 18 studies with a total of 3 660 adult subjects. BNP or NT-proBNP (collectively referred to as NP) guided treatment of heart failure was compared with treatment guided by clinical assessment alone. Heart failure hospital admissions were reduced by NP-guided treatment, but there was uncertainty for all-cause admissions.No statistically significant difference in all-cause mortality or heart failure mortality were observed although the point estimates favoured NP-guided treatment.Six studies (n=1 144) reported on adverse events, but the results could not be pooled. Only 4 studies (n=1 051) provided cost of treatment results, 3 of these studies reported a lower cost for NP-guided treatment, whilst 1 reported a higher cost. The evidence showed uncertainty for quality of life data (MD -0.03, 95% CI -1.18 to 1.13, statistical heterogeneity I2 =75%; 8 studies, n=1 812).
| Outcome | Follow-up | Relative effect (95% CI) | Assumed risk - clinical assessment alone | Corresponding risk - NP-guided (95% CI) | Participants (studies) |
|---|---|---|---|---|---|
| All-cause mortality | 3-54 months | RR 0.87 (0.76 to 1.01) | 218 per 1000 | 190 per 1000(166 to 220) | 3 169(15 studies) |
| Heart failure mortality | 6-24 months | RR 0.84 (0.54 to 1.30) | 91 per 1000 | 76 per 1000(49 to 118) | 853 (6 studies) |
| Heart failure admissions | 12-54 months | RR 0.70 (0.61 to 0.80)* | 337 per 1000 | 264 per 1000(230 to 301) | 1 928(10 studies) |
| All-cause admissions | 3-54 months | RR 0.93 (0.84 to 1.03) | 573 per 1000 | 533 per 1000(481 to 590) | 1 142 (6 studies) |
| *statistical heterogeneity I2 = 60% | |||||
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References
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