Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.
PLoS One
; 8(3): e58287, 2013.
Article
em En
| MEDLINE
| ID: mdl-23472172
ABSTRACT
BACKGROUND:
The role of cardiac natriuretic peptides in the management of patients with chronic heart failure (HF) remains uncertain. The purpose of this study was to evaluate whether natriuretic peptide-guided therapy, compared to clinically-guided therapy, improves mortality and hospitalization rate in patients with chronic HF. METHODOLOGY/PRINCIPALFINDINGS:
MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases were searched for articles reporting natriuretic peptide-guided therapy in HF until August 2012. All randomized trials reporting clinical end-points (all-cause mortality and/or HF-related hospitalization and/or all-cause hospitalization) were included. Meta-analysis was performed to assess the influence of treatment on outcomes. Sensitivity analysis was performed to test the influence of potential effect modifiers and of each trial included in meta-analysis on results. Twelve trials enrolling 2,686 participants were included. Natriuretic peptide-guided therapy (either B-type natriuretic peptide [BNP]- or N-terminal pro-B-type natriuretic peptide [NT-proBNP]-guided therapy) significantly reduced all-cause mortality (Odds Ratio [OR]0.738; 95% Confidence Interval [CI]0.596 to 0.913; p = 0.005) and HF-related hospitalization (OR0.554; CI0.399 to 0.769; p = 0.000), but not all-cause hospitalization (OR0.803; CI0.629 to 1.024; p = 0.077). When separately assessed, NT-proBNP-guided therapy significantly reduced all-cause mortality (OR0.717; CI0.563 to 0.914; p = 0.007) and HF-related hospitalization (OR0.531; CI0.347 to 0.811; p = 0.003), but not all-cause hospitalization (OR0.779; CI0.414 to 1.465; p = 0.438), whereas BNP-guided therapy did not significantly reduce all-cause mortality (OR0.814; CI0.518 to 1.279; p = 0.371), HF-related hospitalization (OR0.599; CI0.303 to 1.187; p = 0.142) or all-cause hospitalization (OR0.726; CI0.509 to 1.035; p = 0.077). [corrected]. CONCLUSIONS/SIGNIFICANCE:
Use of cardiac peptides to guide pharmacologic therapy significantly reduces mortality and HF related hospitalization in patients with chronic HF. In particular, NT-proBNP-guided therapy reduced all-cause mortality and HF-related hospitalization but not all-cause hospitalization, whereas BNP-guided therapy did not significantly reduce both mortality and morbidity.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Fragmentos de Peptídeos
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Peptídeo Natriurético Encefálico
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Natriuréticos
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Insuficiência Cardíaca
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Systematic_reviews
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
PLoS One
Ano de publicação:
2013
Tipo de documento:
Article