B-Type Natriuretic Peptide-Guided Heart Failure Therapy A Meta-analysis

Background: The use of plasma levels of B-type natriuretic peptides (BNPs) to guide treatment of patients with chronic heart failure (HF) has been investigated in a number of randomized controlled trials (RCTs). However, the benefits of this treatment approach have been uncertain. We therefore performed a meta-analysis to examine the overall effect of BNP-guided drug therapy oil cardiovascular outcomes in patients with chronic HF. Methods: We identified RCTs 1)), systematic search of manuscripts, abstracts, and databases. Eligible RCTs were those that enrolled more than 20 patients and involved comparison of BNP-guided drug therapy vs Usual clinical care of the patient with chronic HF in all Outpatient setting. Results: Eight RCTs with a total of 1.726 patients and with a mean duration of 16 months (range, 3-24 months) were included in the meta-analysis. Overall, there was a significantly lower risk of all-cause mortality (relative risk [RR], 0.76; 95% confidence interval [CI], 0.63-0.91; P=.003) in the BNP-guided therapy group compared with the control group. In the subgroup of patients younger than 75),ears, all-cause mortality was also significantly lower in the BNP-guided group (RR, 0.52; 95% CI, 0.33-0.82; P=.005). However, there was no reduction ill mortality With BNP-guided therapy in patients 75 years or older (RR, 0.94; 95% CI, 0.71-1.25; P=.70). The risk of all-cause hospitalization and survival free of any hospitalization was not significantly different between groups (RR, 0.82; 95% Cl, 0.64-1.05; P=.12 and RR, 1.07; 95% CI, 0.85-1,34; P=.58, respectively). The additional percentage of patients achieving target doses of angiotensin-converting enzyme inhibitors and beta-blockers during the course of these trials averaged 2.1% and 22% in the BNP group and 11.7% and 12.5% in the control group, respectively Conclusions: B-tyPe natriuretic peptide-guided therapy reduces all-cause mortality in patients with chronic HF compared with usual clinical care, especially in patients younger than 75 years. A component of this survival benefit may be due to increased use of agents proven to decrease mortality in chronic HF. However, there does not seem to be a reduction in all-cause hospitalization or all increase ill survival free of hospitalization using this approach.