B-type natriuretic peptide-guided therapy for heart failure (HF): a systematic review and meta-analysis of individual participant data (IPD) and aggregate data

Systematic Reviews

Manuel Anguita-Sanchez¹  Theresa McDonagh²  Rachel Maishman³  Lucy Dabner³  Maria Pufulete³  Barnaby C. Reeves³  Chris A. Rogers³  Angus K. Nightingale⁴  Mark Dayer⁵  Patric Karlström⁶  Michael Kleiner Shochat⁷  Morten Schou⁸  John MacLeod⁹  Sarah Purdy⁹  William Hollingworth⁹  Julian P. T. Higgins⁹ 

[1] Agencia de Investigación de la Sociedad Española de Cardiología;Cardiovascular Division, King’s College Hospital, King’s College London;Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol;Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary;Department of Cardiology, Taunton and Somerset NHS Foundation Trust;Division of Cardiology, Department of Medicine, County Hospital Ryhov;Heart Institute, Hillel Yaffe Medical Center;Herlev and Gentofte University Hospital;School of Social and Community Medicine, University of Bristol;

关键词: Heart failure;    B-type natriuretic peptide;    Systematic review;    IPD meta-analysis;   

DOI  :  10.1186/s13643-018-0776-8

来源: DOAJ

【 摘 要 】

Abstract Background We estimated the effectiveness of serial B-type natriuretic peptide (BNP) blood testing to guide up-titration of medication compared with symptom-guided up-titration of medication in patients with heart failure (HF). Methods Systematic review and meta-analysis of randomised controlled trials (RCTs). We searched: MEDLINE (Ovid) 1950 to 9/06/2016; Embase (Ovid), 1980 to 2016 week 23; the Cochrane Library; ISI Web of Science (Citations Index and Conference Proceedings). The primary outcome was all-cause mortality; secondary outcomes were death related to HF, cardiovascular death, all-cause hospital admission, hospital admission for HF, adverse events, and quality of life. IPD were sought from all RCTs identified. Random-effects meta-analyses (two-stage) were used to estimate hazard ratios (HR) and confidence intervals (CIs) across RCTs, including HR estimates from published reports of studies that did not provide IPD. We estimated treatment-by-covariate interactions for age, gender, New York Heart Association (NYHA) class, HF type; diabetes status and baseline BNP subgroups. Dichotomous outcomes were analysed using random-effects odds ratio (OR) with 95% CI. Results We identified 14 eligible RCTs, five providing IPD. BNP-guided therapy reduced the hazard of hospital admission for HF by 19% (13 RCTs, HR 0.81, 95% CI 0.68 to 0.98) but not all-cause mortality (13 RCTs; HR 0.87, 95% CI 0.75 to 1.01) or cardiovascular mortality (5 RCTs; OR 0.88, 95% CI 0.67 to 1.16). For all-cause mortality, there was a significant interaction between treatment strategy and age (p = 0.034, 11 RCTs; HR 0.70, 95% CI 0.53–0.92, patients < 75 years old and HR 1.07, 95% CI 0.84–1.37, patients ≥ 75 years old); ejection fraction (p = 0.026, 11 RCTs; HR 0.84, 95% CI 0.71–0.99, patients with heart failure with reduced ejection fraction (HFrEF); and HR 1.33, 95% CI 0.83–2.11, patients with heart failure with preserved ejection fraction (HFpEF)). Adverse events were significantly more frequent with BNP-guided therapy vs. symptom-guided therapy (5 RCTs; OR 1.29, 95% CI 1.04 to 1.60). Conclusion BNP-guided therapy did not reduce mortality but reduced HF hospitalisation. The overall quality of the evidence varied from low to very low. The relevance of these findings to unselected patients, particularly those managed by community generalists, are unclear. Systematic review registration PROSPERO CRD42013005335

【 授权许可】

Unknown