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Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.

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/PRINCIPAL FINDINGS

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 (OR:0.554; CI:0.399 to 0.769; p = 0.000), but not all-cause hospitalization (OR:0.803; CI:0.629 to 1.024; p = 0.077). When separately assessed, NT-proBNP-guided therapy significantly reduced all-cause mortality (OR:0.717; CI:0.563 to 0.914; p = 0.007) and HF-related hospitalization (OR:0.531; CI:0.347 to 0.811; p = 0.003), but not all-cause hospitalization (OR:0.779; CI:0.414 to 1.465; p = 0.438), whereas BNP-guided therapy did not significantly reduce all-cause mortality (OR:0.814; CI:0.518 to 1.279; p = 0.371), HF-related hospitalization (OR:0.599; CI:0.303 to 1.187; p = 0.142) or all-cause hospitalization (OR:0.726; CI:0.509 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.

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  • Authors+Show Affiliations

    ,

    Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.

    , , , , , ,

    Source

    PloS one 8:3 2013 pg e58287

    MeSH

    Age Factors
    Aged
    Chronic Disease
    Female
    Heart Failure
    Hospitalization
    Humans
    Male
    Middle Aged
    Natriuretic Agents
    Natriuretic Peptide, Brain
    Odds Ratio
    Peptide Fragments
    Randomized Controlled Trials as Topic
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis

    Language

    eng

    PubMed ID

    23472172

    Citation

    Savarese, Gianluigi, et al. "Natriuretic Peptide-guided Therapy in Chronic Heart Failure: a Meta-analysis of 2,686 Patients in 12 Randomized Trials." PloS One, vol. 8, no. 3, 2013, pp. e58287.
    Savarese G, Trimarco B, Dellegrottaglie S, et al. Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials. PLoS ONE. 2013;8(3):e58287.
    Savarese, G., Trimarco, B., Dellegrottaglie, S., Prastaro, M., Gambardella, F., Rengo, G., ... Perrone-Filardi, P. (2013). Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials. PloS One, 8(3), pp. e58287. doi:10.1371/journal.pone.0058287.
    Savarese G, et al. Natriuretic Peptide-guided Therapy in Chronic Heart Failure: a Meta-analysis of 2,686 Patients in 12 Randomized Trials. PLoS ONE. 2013;8(3):e58287. PubMed PMID: 23472172.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials. AU - Savarese,Gianluigi, AU - Trimarco,Bruno, AU - Dellegrottaglie,Santo, AU - Prastaro,Maria, AU - Gambardella,Francesco, AU - Rengo,Giuseppe, AU - Leosco,Dario, AU - Perrone-Filardi,Pasquale, Y1 - 2013/03/05/ PY - 2013/01/03/received PY - 2013/02/01/accepted PY - 2013/3/9/entrez PY - 2013/3/9/pubmed PY - 2013/12/16/medline SP - e58287 EP - e58287 JF - PloS one JO - PLoS ONE VL - 8 IS - 3 N2 - 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/PRINCIPAL FINDINGS: 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 (OR:0.554; CI:0.399 to 0.769; p = 0.000), but not all-cause hospitalization (OR:0.803; CI:0.629 to 1.024; p = 0.077). When separately assessed, NT-proBNP-guided therapy significantly reduced all-cause mortality (OR:0.717; CI:0.563 to 0.914; p = 0.007) and HF-related hospitalization (OR:0.531; CI:0.347 to 0.811; p = 0.003), but not all-cause hospitalization (OR:0.779; CI:0.414 to 1.465; p = 0.438), whereas BNP-guided therapy did not significantly reduce all-cause mortality (OR:0.814; CI:0.518 to 1.279; p = 0.371), HF-related hospitalization (OR:0.599; CI:0.303 to 1.187; p = 0.142) or all-cause hospitalization (OR:0.726; CI:0.509 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/23472172/Natriuretic_peptide_guided_therapy_in_chronic_heart_failure:_a_meta_analysis_of_2686_patients_in_12_randomized_trials_ L2 - http://dx.plos.org/10.1371/journal.pone.0058287 DB - PRIME DP - Unbound Medicine ER -