B-type natriuretic peptide-guided therapy for heart failure (HF): a systematic review and meta-analysis of individual participant data (IPD) and aggregate data
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 contr...
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Format: | Article |
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BMC
2018-07-01
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Series: | Systematic Reviews |
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Online Access: | http://link.springer.com/article/10.1186/s13643-018-0776-8 |
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doaj-ba845ddcaad84227a1963e8edab571a2 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Maria Pufulete Rachel Maishman Lucy Dabner Julian P. T. Higgins Chris A. Rogers Mark Dayer John MacLeod Sarah Purdy William Hollingworth Morten Schou Manuel Anguita-Sanchez Patric Karlström Michael Kleiner Shochat Theresa McDonagh Angus K. Nightingale Barnaby C. Reeves |
spellingShingle |
Maria Pufulete Rachel Maishman Lucy Dabner Julian P. T. Higgins Chris A. Rogers Mark Dayer John MacLeod Sarah Purdy William Hollingworth Morten Schou Manuel Anguita-Sanchez Patric Karlström Michael Kleiner Shochat Theresa McDonagh Angus K. Nightingale Barnaby C. Reeves 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 Heart failure B-type natriuretic peptide Systematic review IPD meta-analysis |
author_facet |
Maria Pufulete Rachel Maishman Lucy Dabner Julian P. T. Higgins Chris A. Rogers Mark Dayer John MacLeod Sarah Purdy William Hollingworth Morten Schou Manuel Anguita-Sanchez Patric Karlström Michael Kleiner Shochat Theresa McDonagh Angus K. Nightingale Barnaby C. Reeves |
author_sort |
Maria Pufulete |
title |
B-type natriuretic peptide-guided therapy for heart failure (HF): a systematic review and meta-analysis of individual participant data (IPD) and aggregate data |
title_short |
B-type natriuretic peptide-guided therapy for heart failure (HF): a systematic review and meta-analysis of individual participant data (IPD) and aggregate data |
title_full |
B-type natriuretic peptide-guided therapy for heart failure (HF): a systematic review and meta-analysis of individual participant data (IPD) and aggregate data |
title_fullStr |
B-type natriuretic peptide-guided therapy for heart failure (HF): a systematic review and meta-analysis of individual participant data (IPD) and aggregate data |
title_full_unstemmed |
B-type natriuretic peptide-guided therapy for heart failure (HF): a systematic review and meta-analysis of individual participant data (IPD) and aggregate data |
title_sort |
b-type natriuretic peptide-guided therapy for heart failure (hf): a systematic review and meta-analysis of individual participant data (ipd) and aggregate data |
publisher |
BMC |
series |
Systematic Reviews |
issn |
2046-4053 |
publishDate |
2018-07-01 |
description |
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 |
topic |
Heart failure B-type natriuretic peptide Systematic review IPD meta-analysis |
url |
http://link.springer.com/article/10.1186/s13643-018-0776-8 |
work_keys_str_mv |
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doaj-ba845ddcaad84227a1963e8edab571a22020-11-24T20:40:34ZengBMCSystematic Reviews2046-40532018-07-017112110.1186/s13643-018-0776-8B-type natriuretic peptide-guided therapy for heart failure (HF): a systematic review and meta-analysis of individual participant data (IPD) and aggregate dataMaria Pufulete0Rachel Maishman1Lucy Dabner2Julian P. T. Higgins3Chris A. Rogers4Mark Dayer5John MacLeod6Sarah Purdy7William Hollingworth8Morten Schou9Manuel Anguita-Sanchez10Patric Karlström11Michael Kleiner Shochat12Theresa McDonagh13Angus K. Nightingale14Barnaby C. Reeves15Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of BristolClinical Trials and Evaluation Unit, School of Clinical Sciences, University of BristolClinical Trials and Evaluation Unit, School of Clinical Sciences, University of BristolSchool of Social and Community Medicine, University of BristolClinical Trials and Evaluation Unit, School of Clinical Sciences, University of BristolDepartment of Cardiology, Taunton and Somerset NHS Foundation TrustSchool of Social and Community Medicine, University of BristolSchool of Social and Community Medicine, University of BristolSchool of Social and Community Medicine, University of BristolHerlev and Gentofte University HospitalAgencia de Investigación de la Sociedad Española de CardiologíaDivision of Cardiology, Department of Medicine, County Hospital RyhovHeart Institute, Hillel Yaffe Medical CenterCardiovascular Division, King’s College Hospital, King’s College LondonDepartment of Cardiology, Bristol Heart Institute, Bristol Royal InfirmaryClinical Trials and Evaluation Unit, School of Clinical Sciences, University of BristolAbstract 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 CRD42013005335http://link.springer.com/article/10.1186/s13643-018-0776-8Heart failureB-type natriuretic peptideSystematic reviewIPD meta-analysis |