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Evidence summaries

B-Type Natriuretic Peptide-Guided Treatment for Heart Failure

BNP or NT-proBNP guided treatment may reduce heart failure admissions compared to treatment of heart failure guided by clinical assessment alone. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (lack of blinding) and by inconsistency (variability in results).

Summary

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).

Treatment guided by serial BNP or NT-proBNP monitoring compared with treatment guided by clinical assessment alone

OutcomeFollow-upRelative effect (95% CI)Assumed risk - clinical assessment aloneCorresponding risk - NP-guided (95% CI)Participants (studies)
All-cause mortality3-54 monthsRR 0.87 (0.76 to 1.01)218 per 1000190 per 1000(166 to 220)3 169(15 studies)
Heart failure mortality6-24 monthsRR 0.84 (0.54 to 1.30)91 per 100076 per 1000(49 to 118)853 (6 studies)
Heart failure admissions12-54 monthsRR 0.70 (0.61 to 0.80)*337 per 1000264 per 1000(230 to 301)1 928(10 studies)
All-cause admissions3-54 monthsRR 0.93 (0.84 to 1.03)573 per 1000533 per 1000(481 to 590)1 142 (6 studies)
*statistical heterogeneity I2 = 60%
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