Natriuretic peptide-guided treatment for heart failure: a systematic review and meta-analysis.
BMJ Evid Based Med
; 25(1): 33-37, 2020 02.
Article
en En
| MEDLINE
| ID: mdl-31326896
ABSTRACT
BACKGROUND:
GUIDE-IT, the largest trial to date, published in August 2017, evaluating the effectiveness of natriuretic peptide (NP)-guided treatment of heart failure (HF), was stopped early for futility on a composite outcome. However, the reported effect sizes on individual outcomes of all-cause mortality and HF admissions are potentially clinically relevant.OBJECTIVE:
This systematic review and meta-analysis aims to combine all available trial level evidence to determine if NP-guided treatment of HF reduces all-cause mortality and HF admissions in patients with HF. STUDY SELECTION Eight databases, no language restrictions, up to November 2017 were searched for all randomised controlled trials comparing NP-guided treatment versus clinical assessment alone in adult patients with HF. 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% CI 0.77 to 0.99 and 0.80, 95% CI 0.72 to 0.89 for HF 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 HF admissions and all-cause mortality. However, there is still insufficient high-quality evidence to make definitive recommendations on the use of NP-guided treatment in clinical practice. TRIAL REGISTRATION NUMBER Systematic Review Cochrane Database Number CD008966.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Péptido Natriurético Encefálico
/
Insuficiencia Cardíaca
Tipo de estudio:
Clinical_trials
/
Guideline
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
BMJ Evid Based Med
Año:
2020
Tipo del documento:
Article
País de afiliación:
Reino Unido