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Review
. 2016 Dec;12(12):CD008966.
doi: 10.1002/14651858.CD008966.pub2. Epub 2016 Dec 22.

B-type natriuretic peptide-guided treatment for heart failure

Julie McLellan  1 , Carl J Heneghan  1 , Rafael Perera  1 , Alison M Clements  1 , Paul P Glasziou  2 , Karen E Kearley  1 , Nicola Pidduck  1 , Nia W Roberts  3 , Sally Tyndel  1 , F Lucy Wright  4 , Clare Bankhead  1
Affiliations
Review

B-type natriuretic peptide-guided treatment for heart failure

Julie McLellan et al. Cochrane Database Syst Rev. 2016 Dec.

Abstract

Background: Heart failure is a condition in which the heart does not pump enough blood to meet all the needs of the body. Symptoms of heart failure include breathlessness, fatigue and fluid retention. Outcomes for patients with heart failure are highly variable; however on average, these patients have a poor prognosis. Prognosis can be improved with early diagnosis and appropriate use of medical treatment, use of devices and transplantation. Patients with heart failure are high users of healthcare resources, not only due to drug and device treatments, but due to high costs of hospitalisation care. B-type natriuretic peptide levels are already used as biomarkers for diagnosis and prognosis of heart failure, but could offer to clinicians a possible tool to guide drug treatment. This could optimise drug management in heart failure patients whilst allaying concerns over potential side effects due to drug intolerance.

Objectives: To assess whether treatment guided by serial BNP or NT-proBNP (collectively referred to as NP) monitoring improves outcomes compared with treatment guided by clinical assessment alone.

Search methods: Searches were conducted up to 15 March 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (OVID), Embase (OVID), the Database of Abstracts of Reviews of Effects (DARE) and the NHS Economic Evaluation Database in the Cochrane Library. Searches were also conducted in the Science Citation Index Expanded, the Conference Proceedings Citation Index on Web of Science (Thomson Reuters), World Health Organization International Clinical Trials Registry and ClinicalTrials.gov. We applied no date or language restrictions.

Selection criteria: We included randomised controlled trials of NP-guided treatment of heart failure versus treatment guided by clinical assessment alone with no restriction on follow-up. Adults treated for heart failure, in both in-hospital and out-of-hospital settings, and trials reporting a clinical outcome were included.

Data collection and analysis: Two review authors independently selected studies for inclusion, extracted data and evaluated risk of bias. Risk ratios (RR) were calculated for dichotomous data, and pooled mean differences (MD) (with 95% confidence intervals (CI)) were calculated for continuous data. We contacted trial authors to obtain missing data. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, we assessed the quality of the evidence and GRADE profiler (GRADEPRO) was used to import data from Review Manager to create a 'Summary of findings' table.

Main results: We included 18 randomised controlled trials with 3660 participants (range of mean age: 57 to 80 years) comparing NP-guided treatment with clinical assessment alone. The evidence for all-cause mortality using NP-guided treatment showed uncertainty (RR 0.87, 95% CI 0.76 to 1.01; patients = 3169; studies = 15; low quality of the evidence), and for heart failure mortality (RR 0.84, 95% CI 0.54 to 1.30; patients = 853; studies = 6; low quality of evidence).The evidence suggested heart failure admission was reduced by NP-guided treatment (38% versus 26%, RR 0.70, 95% CI 0.61 to 0.80; patients = 1928; studies = 10; low quality of evidence), but the evidence showed uncertainty for all-cause admission (57% versus 53%, RR 0.93, 95% CI 0.84 to 1.03; patients = 1142; studies = 6; low quality of evidence).Six studies reported on adverse events, however the results could not be pooled (patients = 1144; low quality of evidence). Only four studies provided cost of treatment results, three of these studies reported a lower cost for NP-guided treatment, whilst one reported a higher cost (results were not pooled; patients = 931, low quality of evidence). The evidence showed uncertainty for quality of life data (MD -0.03, 95% CI -1.18 to 1.13; patients = 1812; studies = 8; very low quality of evidence).We completed a 'Risk of bias' assessment for all studies. The impact of risk of bias from lack of blinding of outcome assessment and high attrition levels was examined by restricting analyses to only low 'Risk of bias' studies.

Authors' conclusions: In patients with heart failure low-quality evidence showed a reduction in heart failure admission with NP-guided treatment while low-quality evidence showed uncertainty in the effect of NP-guided treatment for all-cause mortality, heart failure mortality, and all-cause admission. Uncertainty in the effect was further shown by very low-quality evidence for patient's quality of life. The evidence for adverse events and cost of treatment was low quality and we were unable to pool results.

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Conflict of interest statement

Julie McLellan has no known potential conflicts of interest.

Carl Heneghan receives funding from the NIHR School of Primary Care Research (SPCR) and the NIHR Diagnostic Evidence Co‐operative (DEC).

Rafael Perera receives funding from the NIHR Oxford Biomedical Research Centre Programme, the NIHR Programme for Applied Research, the NIHR HPRU Gastrointestinal Infections Group, and the NIHR Diagnostic Evidence Co‐operative (DEC).

Alison M Clements has no known potential conflicts of interest.

Paul P Glasziou has no known potential conflicts of interest.

Karen E Kearley has no known potential conflicts of interest.

Nicola Pidduck has no known potential conflicts of interest.

Nia W Roberts has no known potential conflicts of interest.

Sally Tyndel has no known potential conflicts of interest.

F Lucy Wright has no known potential conflicts of interest.

Clare Bankhead has no known potential conflicts of interest.

Figures

1
1
Study flow diagram.
4
4
Funnel plot of comparison: NP‐guided versus no NP‐guided treatment for all‐cause mortality.
2
2
'Risk of bias' summary: review authors' judgements about methodological quality for each included study
3
3
'Risk of bias' graph: review authors' judgements about methodological quality presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Primary objective BNP vs no BNP, Outcome 1 All‐cause mortality.
1.2
1.2. Analysis
Comparison 1 Primary objective BNP vs no BNP, Outcome 2 Heart failure mortality.
1.3
1.3. Analysis
Comparison 1 Primary objective BNP vs no BNP, Outcome 3 Heart failure admission.
1.4
1.4. Analysis
Comparison 1 Primary objective BNP vs no BNP, Outcome 4 All‐cause admission.
1.5
1.5. Analysis
Comparison 1 Primary objective BNP vs no BNP, Outcome 5 Quality of life.
2.1
2.1. Analysis
Comparison 2 Clincal vs UC in primary objectives, Outcome 1 All‐cause mortality.
2.2
2.2. Analysis
Comparison 2 Clincal vs UC in primary objectives, Outcome 2 Heart failure mortality.
2.3
2.3. Analysis
Comparison 2 Clincal vs UC in primary objectives, Outcome 3 Heart failure admission.
2.4
2.4. Analysis
Comparison 2 Clincal vs UC in primary objectives, Outcome 4 All‐cause admission.
2.5
2.5. Analysis
Comparison 2 Clincal vs UC in primary objectives, Outcome 5 Quality of life.
3.1
3.1. Analysis
Comparison 3 Subgroup analyses, Outcome 1 All‐cause mortality and age.
3.2
3.2. Analysis
Comparison 3 Subgroup analyses, Outcome 2 Heart failure admission and age.
4.1
4.1. Analysis
Comparison 4 Sensitivity analyses: Outcome blinding, Outcome 1 All‐cause mortality.
4.2
4.2. Analysis
Comparison 4 Sensitivity analyses: Outcome blinding, Outcome 2 Heart failure mortality.
4.3
4.3. Analysis
Comparison 4 Sensitivity analyses: Outcome blinding, Outcome 3 Heart failure admission.
4.4
4.4. Analysis
Comparison 4 Sensitivity analyses: Outcome blinding, Outcome 4 All‐cause admission.
4.5
4.5. Analysis
Comparison 4 Sensitivity analyses: Outcome blinding, Outcome 5 Quality of life.
5.1
5.1. Analysis
Comparison 5 Sensitivity analyses: Attrition, Outcome 1 All‐cause mortality.
5.2
5.2. Analysis
Comparison 5 Sensitivity analyses: Attrition, Outcome 2 Heart failure mortality.
5.3
5.3. Analysis
Comparison 5 Sensitivity analyses: Attrition, Outcome 3 Heart failure admission.
5.4
5.4. Analysis
Comparison 5 Sensitivity analyses: Attrition, Outcome 4 All‐cause admission.
5.5
5.5. Analysis
Comparison 5 Sensitivity analyses: Attrition, Outcome 5 Quality of life.
6.1
6.1. Analysis
Comparison 6 Duration of FU BNP vs no BNP, Outcome 1 All‐cause mortality.
6.2
6.2. Analysis
Comparison 6 Duration of FU BNP vs no BNP, Outcome 2 Heart failure mortality.
6.3
6.3. Analysis
Comparison 6 Duration of FU BNP vs no BNP, Outcome 3 Heart failure admission.
6.4
6.4. Analysis
Comparison 6 Duration of FU BNP vs no BNP, Outcome 4 All‐cause admission.
6.5
6.5. Analysis
Comparison 6 Duration of FU BNP vs no BNP, Outcome 5 Quality of life.
7.1
7.1. Analysis
Comparison 7 Subgroup: BNP vs NT‐proBNP, Outcome 1 All‐cause mortality.
7.2
7.2. Analysis
Comparison 7 Subgroup: BNP vs NT‐proBNP, Outcome 2 Heart failure mortality.
7.3
7.3. Analysis
Comparison 7 Subgroup: BNP vs NT‐proBNP, Outcome 3 Heart failure admission.
7.4
7.4. Analysis
Comparison 7 Subgroup: BNP vs NT‐proBNP, Outcome 4 All‐cause admission.
7.5
7.5. Analysis
Comparison 7 Subgroup: BNP vs NT‐proBNP, Outcome 5 Quality of life.
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References

References to studies included in this review

Anguita 2010 {published data only}
    1. Anguita M, Esteban F, Castillo JC, Mazuelos F, Lopez‐Granados A, Arizon JM, et al. Usefulness of brain natriuretic peptide levels, as compared with usual clinical control, for the treatment monitoring of patients with heart failure. Medicina Clinica 2010;135(10):435‐40. - PubMed
Beck‐da‐Silva 2005 {published data only}
    1. Beck‐da‐Silva L, Bold A, Fraser M, Williams K, Haddad H. BNP‐guided therapy not better than expert's clinical assessment for beta‐blocker titration in patients with heart failure. Congestive Heart Failure 2005;11(5):248‐53. - PubMed
Berger 2010 {published data only}
    1. Adlbrecht C, Huelsmann M, Berger R, Moertl D, Strunk G, Oesterle A, et al. Cost analysis and cost‐effectiveness of NT‐proBNP‐guided heart failure specialist care in addition to home‐based nurse care. European Journal of Clinical Investigation 2011;41(3):315‐22. - PubMed
    1. Berger R, Moertl D, Peter S, Ahmadi R, Huelsmann M, Yamuti S, et al. N‐terminal pro‐B‐type natriuretic peptide‐guided, intensive patient management in addition to multidisciplinary care in chronic heart failure a 3‐arm, prospective, randomised pilot study. Journal of the American College of Cardiology 2010;55(7):645‐53. - PubMed
Eurlings 2010 {published data only}
    1. Eurlings LW, Sanders‐van Wijk S, Kraaij DJW, Kimmenade R, Meeder JG, Kamp O, et al. Risk stratification with the use of serial N‐terminal pro‐B‐type natriuretic peptide measurements during admission and early after discharge in heart failure patients: post hoc analysis of the PRIMA study. Journal of Cardiac Failure 2014;20(12):881‐90. - PubMed
    1. Eurlings LWM, Pol PEJ, Kok WE, Wijk S, Lodewijks‐van der Bolt C, Balk AHMM, et al. Management of chronic heart failure guided by individual N‐terminal pro‐B‐type natriuretic peptide targets: results of the PRIMA (Can PRo‐brain‐natriuretic peptide guided therapy of chronic heart failure IMprove heart fAilure morbidity and mortality?) study. Journal of the American College of Cardiology 2010;56(25):2090‐100. - PubMed
Januzzi 2011 {published data only}
    1. Bhardwaj A, Rehman SU, Mohammed AA, Gaggin HK, Barajas L, Barajas J, et al. Quality of life and chronic heart failure therapy guided by natriuretic peptides: results from the ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) study. American Heart Journal 2012;164(5):793‐99. - PubMed
    1. Bhardwaj A, Rehman SU, Mohammed AA, Han‐na K, Barajas L, Barajas J, et al. NT‐ProBNP guided therapy improves the quality of life in patients with chronic heart failure. Results from the ProBNP outpatient tailored chronic heart failure therapy study. Circulation. 2011; Vol. 124, issue 21 Suppl.1:A13596.
    1. Bhardwaj A, Rehman SU, Mohammed AA, Kim HN, Barajas L, Barajas J, et al. NT‐proBNP guided therapy improves the quality of life in patients with chronic heart failure. Results from the ProBNP outpatient tailored chronic heart failure therapy study. Journal of Cardiac Failure 2011;17(8 Suppl 1):S94‐5.
    1. Bhardwaj A, Rehman SU, Mohammed Asim, Baggish AL, Moore SA, Januzzi JL. Design and methods of the Pro‐B Type Natriuretic Peptide Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) Study. American Heart Journal 2010;159(4):532‐8. - PubMed
    1. Dudzinski DM, Gaggin HK, Belcher A, Berardinis B, He W, Januzzi JL. NT‐proBNP Guided outpatient management of systolic heart failure is cost‐saving. Circulation. 2012; Vol. 126, issue 21 SUPPL.1:A13263.
Jourdain 2007 {published data only}
    1. Jourdain P, Jondeau G, Funck F, Gueffet P, Helloco A, Donal E, et al. Plasma brain natriuretic peptide‐guided therapy to improve outcome in heart failure: the STARS‐BNP Multicenter Study. Journal of the American College of Cardiology 2007;49(16):1733‐9. - PubMed
Karlstrom 2011 {published data only}
    1. Karlstrom P, Alehagenm U, Boman K, Dahlstrom U, U.PSTEP‐study group. Brain natriuretic peptide‐guided treatment does not improve morbidity and mortality in extensively treated patients with chronic heart failure: responders to treatment have a significantly better outcome.[Erratum appears in Eur J Heart Fail. 2012 May;14(5):563 Note: von den Luederer Tomas [corrected to von Lueder, Thomas G]]. European Journal of Heart Failure 2011;13(10):1096‐103. - PubMed
    1. Karlstrom P, Dahlstrom U, Boman K, Alehagen U. Responder to BNP‐guided treatment in heart failure. The process of defining a responder Results from the Use of PeptideS in Tailoring hEart failure Project or UPSTEP study. Scandinavian Cardiovascular Journal 2015;49(6):316‐24. - PubMed
    1. Karlstrom P, Johansson P, Dahlstrom U, Boman K, Alehagen U. Can BNP‐guided therapy improve health‐related quality of life, and do responders to BNP‐guided heart failure treatment have improved health‐related quality of life? Results from the UPSTEP study. BMC Cardiovascular Disorders 2016;16(1):39. - PMC - PubMed
Krupicka 2010 {published data only}
    1. Hradec J, Krupicka J, Janota T. [Will the therapy of chronic heart failure be guided by plasma levels of natriuretic peptides?]. Casopis Lekaru Ceskych 2009;148(8):383‐8. - PubMed
    1. Krupicka J, Janota T, Hradec J. Optimalization of heart failure therapy guided by plasma BNP concentrations. European Society of Cardiology 2010;Conference: European Society of Cardiology, ESC Congress 2010 Stockholm Sweden. Conference Start: 20100828 Conference End: 20100901. Conference Publication: (var.pagings). 31:859‐60.
    1. Krupicka J, Janota T, Kasalova Z, Hradec J. Natriuretic peptides ‐ physiology, pathophysiology and clinical use in heart failure. Physiological Research 2009;58(2):171‐7. - PubMed
Lainchbury 2010 {published data only}
    1. Lainchbury JG, Troughton R, Strangman KM, Frampton CM, Pilbrow A, Yandle TG, et al. N‐terminal pro‐B‐type natriuretic peptide‐guided treatment for chronic heart failure: results from the BATTLESCARRED (NT‐proBNP‐Assisted Treatment To Lessen Serial Cardiac Readmissions and Death) trial. Journal of the American College of Cardiology 2010;55(1):53‐60. - PubMed
    1. Lainchbury JG, Troughton RW, Frampton CM, Yandle TG, Hamid A, Nicholls M, et al. NTproBNP‐guided drug treatment for chronic heart failure: design and methods in the "BATTLESCARRED" trial. European Journal of Heart Failure 2006;8(5):532‐8. - PubMed
Li 2015 {published data only}
    1. Li JJ, Xiang XL, Tian XY, Shi YF. Clinical research on brain natriuretic peptide guiding the application of beta1 receptor blocker in patients with moderate to severe heart failure. Acta Cardiologica Sinica 2015;31(1):52‐8. - PMC - PubMed
Maeder 2013 {published data only}
    1. Brunner‐La Rocca HP, Buser PT, Schindler R, Bernheim A, Rickenbacher P, Pfisterer M, et al. Management of elderly patients with congestive heart failure‐‐design of the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME‐CHF). American Heart Journal 2006;151(5):949‐55. - PubMed
    1. Brunner‐La Rocca HP, Maeder MT, Muzzarelli S, Rickenbacher P, Gutmann M, Jeker U, et al. Does response to therapy differ between preserved and reduced LV systolic function in heart failure? Results from TIME‐CHF. European Journal of Heart Failure, Supplement 2010;Conference: Heart Failure 2010 Congress Berlin Germany. Conference Start: 20100529 Conference End: 20100601. Conference Publication: (var.pagings). 9:S116.
    1. Kaufmann BA, Min SY, Goetschalckx K, Bernheim AM, Buser PT, Pfisterer ME, et al. How reliable are left ventricular ejection fraction cut offs assessed by echocardiography for clinical decision making in patients with heart failure?. International Journal of Cardiovascular Imaging 2013;29(3):581‐8. - PubMed
    1. Maeder MT, Rickenbacher P, Rickli H, Abbu H, Gutmann M, Erne P, et al. N‐terminal pro brain natriuretic peptide‐guided management in patients with heart failure and preserved ejection fraction: findings from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME‐CHF). European Journal of Heart Failure 2013;15:1148‐56. - PubMed
    1. Maeder MT, Rickli H, Pfisterer ME, Muzzarelli S, Ammann P, Fehr T, et al. Incidence, clinical predictors, and prognostic impact of worsening renal function in elderly patients with chronic heart failure on intensive medical therapy. American Heart Journal 2012;163(3):407‐14. - PubMed
Persson 2010 {published data only}
    1. Drexler B, Mueller C. Natriuretic peptide‐guided management by the general practitioner: how to interpret the SIGNAL. European Journal of Heart Failure 2010;12(12):1265‐7. - PubMed
    1. Erntell H, Swedberg K, Jorgensen L, Dahlstrom U, Persson H. Predictors of NT‐proBNP response in primary care patients with heart failure and NT‐proBNP guided therapy. European Journal of Heart Failure 2013;Conference: Heart Failure Congress 2013 Lisbon Portugal. Conference Start: 20130525 Conference End: 20130528. Conference Publication: (var.pagings). 12:S31.
    1. NCT00391846. A single blind, multicentre, 9‐month, phase IV study, comparing treatment guided by clinical symptoms and signs and NT‐proBNP vs treatment guided by clinical symptoms and signs alone, in patients with heart failure (HF) and left ventricular systolic dysfunction. http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/961/CN‐0096... 2006.
    1. Persson H, Erntell H, Eriksson B, Johansson G, Swedberg K, Dahlstrom U. Improved pharmacological therapy of chronic heart failure in primary care: a randomized Study of NT‐proBNP Guided Management of Heart Failure‐‐SIGNAL‐HF (Swedish Intervention study‐‐Guidelines and NT‐proBNP AnaLysis in Heart Failure). European Journal of Heart Failure 2010;12(12):1300‐8. - PubMed
Pfisterer 2009 {published data only}
    1. Brunner‐La Rocca HP, Buser PT, Schindler R, Bernheim A, Rickenbacher P, Pfisterer M, et al. Management of elderly patients with congestive heart failure‐‐design of the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME‐CHF). American Heart Journal 2006;151(5):949‐55. - PubMed
    1. Brunner‐La Rocca HP, Knackstedt C, Eurlings L, Rolny V, Krause F, Pfisterer ME, et al. Impact of worsening renal function related to medication in heart failure. European Journal of Heart Failure 2015;17(2):159‐68. - PubMed
    1. Brunner‐La Rocca HP, Maeder MT, Muzzarelli S, Rickenbacher P, Gutmann M, Jeker U, et al. Does response to therapy differ between preserved and reduced LV systolic function in heart failure? Results from TIME‐CHF. European Journal of Heart Failure, Supplement 2010;Conference: Heart Failure 2010 Congress Berlin Germany. Conference Start: 20100529 Conference End: 20100601. Conference Publication: (var.pagings). 9:S116.
    1. Kaufmann BA, Goetschalckx K, Min SY, Maeder MT, Bucher U, Nietlispach F, et al. TIME‐CHF investigators. Improvement in left ventricular ejection fraction and reverse remodeling in elderly heart failure patients on intense NT‐proBNP‐guided therapy. International Journal of Cardiology 2015;191:286‐93. - PubMed
    1. Kaufmann BA, Min SY, Goetschalck K, Bernhei A, Pfistere M, Rocca HB. Evolution of left ventricular ejection fraction and left ventricular volumes in elderly heart failure patients under modern heart failure therapy: Influence of BNP‐guided therapy. American Heart Association. 2012; Vol. 126, issue 21 Suppl. 1:A17200.
Schou 2013 {published data only}
    1. Schou M, Gislason G, Videbaek L, Kober L, Tuxen C, Torp‐Pedersen C, et al. Effect of extended follow‐up in a specialized heart failure clinic on adherence to guideline recommended therapy: NorthStar Adherence Study. European Journal of Heart Failure 2014;16(11):1249‐55. - PubMed
    1. Schou M, Gustafsson F, Videbaek L, Andersen H, Toft J, Nyvad O, et al. Adding serial N‐terminal pro brain natriuretic peptide measurements to optimal clinical management in outpatients with systolic heart failure: a multicentre randomized clinical trial (NorthStar monitoring study). European Journal of Heart Failure 2013;15(7):818‐27. - PubMed
    1. Schou M, Gustafsson F, Videbaek L, Markenvard J, Ulriksen H, Ryde H, et al. Design and methodology of the NorthStar Study: NT‐proBNP stratified follow‐up in outpatient heart failure clinics ‐‐ a randomized Danish multicenter study. American Heart Journal 2008;156(4):649‐55. - PubMed
Shah 2011 {published data only}
    1. Shah MR, Califf RM, Nohria A, Bhapkar M, Bowers M, Mancini DM, et al. Erratum: The STARBRITE Trial: A Randomized, Pilot Study of B‐Type Natriuretic Peptide ‐ Guided Therapy in Patients With Advanced Heart Failure (Journal of Cardiac Failure (2011) 17 (613‐621)). Journal of Cardiac Failure 2011;17(9):788. - PubMed
    1. Shah MR, Califf RM, Nohria A, Bhapkar M, Bowers M, Mancini DM, et al. The STARBRITE trial: a randomized, pilot study of B‐type natriuretic peptide‐guided therapy in patients with advanced heart failure.[Erratum appears in J Card Fail. 2011 Sep;17(9):788]. Journal of Cardiac Failure 2011;17(8):613‐21. - PubMed
    1. Shah MR, Claise KA, Bowers MT, Bhapkar M, Little J, Nohria A, et al. Testing new targets of therapy in advanced heart failure: the design and rationale of the Strategies for Tailoring Advanced Heart Failure Regimens in the Outpatient Setting: BRain NatrIuretic Peptide Versus the Clinical CongesTion ScorE (STARBRITE) trial. American Heart Journal 2005;150(5):893‐8. - PubMed
Shochat 2012 {published data only}
    1. Shochat M, Shotan A, Dahan I, Shochat I, Levy Y, Asif A, et al. NT‐proBNP‐guided preemptive treatment of outpatients with chronic heart failure followed in a out hospital clinic. Journal of Cardiac Failure 2011;Conference: 15th Annual Scientific Meeting, Heart Failure Society of America Boston, MA United States. Conference Start: 20110918 Conference End: 20110921. Conference Publication:(var.pagings). 17 (8 SUPPL. 1):S56.
    1. Shochat M, Shotan A, Kazatsker M, Asif A, Dahan I, Shochat, I, et al. NT‐proBNP‐guided preemptive treatment of outpatients with chronic heart failure followed in a out hospital clinic. Journal of Cardiac Failure 2012;Conference: 16th Annual Scientific Meeting of the Heart Failure Society of America, HFSA 2012 Seattle, WA United States. Conference Start: 20120909 Conference End: 20120912. Conference Publication::S58.
Skvortsov 2015 {published data only}
    1. Koshkina D, Skvortsov A, Narusov O, Protasov V, Nasonova S, Masenko V, et al. NT‐proBNP‐guided treatment of high risk heart failure patients after acute decompensation. European Heart Journal. 2015; Vol. 36:153‐4.
    1. Koshkina D, Skvortsov A, Protasov V, Narusov O, Masenko V, Tereschenko S. Biomarkers activity and the effect of NT‐proBNP guided therapy in high risk patients with chronic heart failure after acute decompensation. European Journal of Heart Failure. 2015; Vol. 17:142.
    1. Skvortsov A, Koshkina D, Protasov V, Narusov O, Masenko V, Tereschenko S. Treatment optimisation of high risk heart failure patients after acute decompensation by NT‐proBNP monitoring. European Journal of Heart Failure. 2015; Vol. 17:421.
    1. Skvortsov AA, Koshkina DE, Protasov VN, Narusov OY, Masenko VP, Tereschchenko SN. NT‐proBNP‐guided therapy reduces risk of death and hospitalisation in patients after decompensation of heart failure [Терапия под контролем NT‐proBNP снижает рисксмерти и частоту госпитализаций у больных последекомпенсации сердечной недостаточности]. Russian Heart Failure Journal 2015;16(4):204‐17.
Troughton 2000 {published data only}
    1. Nicholls MG, Lainchbury JG, Richards AM, Troughton RW, Yandle TG. Brain natriuretic peptide‐guided therapy for heart failure. Annals of Medicine 2001;33(6):422‐7. - PubMed
    1. Troughton RW, Frampton CM, Yandle TG, Espiner EA, Nicholls MG, Richards AM. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N‐BNP) concentrations. Lancet 2000;355(9210):1126‐30. - PubMed

References to studies excluded from this review

Brunner‐La Rocca 2015 {published data only}
    1. Brunner‐La Rocca HP, Eurlings L, Richards AM, Januzzi JL, Pfisterer ME, Dahlstrom U, et al. Which heart failure patients profit from natriuretic peptide guided therapy? A meta‐analysis from individual patient data of randomised trials. European Journal of Heart Failure 2015;17(12):1252‐61. - PubMed
ChiCTR‐TRC‐08000284 {unpublished data only}
    1. ChiCTR‐TRC‐08000284. Randomized, double‐blind, placebo‐controlled study of recombinant B‐type natriuretic peptide in subjects with acute decompensated congestive heart failure. www.chictr.org/en/proj/show.aspx?proj=1111 (accessed 16 December 2014).
Cocco 2015 {published data only}
    1. Cocco G, Jerie P. Assessing the benefits of natriuretic peptides‐guided therapy in chronic heart failure. Cardiology Journal 2015;22(1):5‐11. - PubMed
Dandamudi 2012 {published data only}
    1. Dandamudi S, Chen HH. The ASCEND‐HF trial: an acute study of clinical effectiveness of nesiritide and decompensated heart failure. Expert Review of Cardiovascular Therapy 2012;10(5):557‐63. - PubMed
De Vecchis 2013 {published data only}
    1. Vecchis R, Esposito C, Biase G, Ariano C. B‐type natriuretic peptide. Guided vs conventional care in outpatients with chronic heart failure: a retrospective study. Minerva Cardioangiologica 2013;61(4):437‐49. - PubMed
Di Somma 2008 {published data only}
    1. Somma S, Magrini L, Tabacco F, Marino R, Talucci V, Marrocco F, et al. Brain natriuretic peptide and N‐terminal pro‐B‐type natriuretic peptide show a different profile in response to acute decompensated heart failure treatment. Congestive Heart Failure 2008;14(5):245‐50. - PubMed
Dong 2014 {published data only}
    1. Dong SY, Dong M, Chen ZH, Sun J, Yang X, Zeng Q. Dynamic use of B‐Type natriuretic peptide‐guided acute coronary syndrome therapy. American Journal of the Medical Sciences 2014;348(4):283‐7. - PubMed
El‐Muayed 2004 {published data only}
    1. El‐Muayed M, Lavis VR, Safi HJ, Fuentes F. Use of glitazones in cardiac patients: a case for B‐type natriuretic peptide monitoring?. American Journal of Cardiology 2004;93(5):600‐2. - PubMed
Felker 2006 {published data only}
    1. Felker GM, Petersen JW, Mark DB. Natriuretic peptides in the diagnosis and management of heart failure. Canadian Medical Association Journal 2006;175(6):611‐7. - PMC - PubMed
Gaggin 2013 {published data only}
    1. Gaggin HK, Truong QA, Rehman SU, Mohammed AA, Bhardwaj A, Parks KA, et al. Characterization and prediction of natriuretic peptide "nonresponse" during heart failure management: results from the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) and the NT‐proBNP‐Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) study. Congestive Heart Failure 2013;19(3):135‐42. - PubMed
Gonzalez 2012 {published data only}
    1. Gonzalez S, Kilpatrick ES, Atkin SL. The biological variation of N‐terminal pro‐brain natriuretic peptide in postmenopausal women with type 2 diabetes: a case control study. PLoS ONE [Electronic Resource] 2012;7(11):e47191. - PMC - PubMed
Green 2009 {published data only}
    1. Green SM, Green JA, Januzzi JL. Natriuretic peptide testing for heart failure therapy guidance in the inpatient and outpatient setting. American Journal of Therapeutics 2009;16(2):171‐7. - PubMed
Jernberg 2003 {published data only}
    1. JernbergT, Lindahl B, Siegbahn A, Andren B, Frostfeldt G, Lagerqvist B, et al. N‐terminal pro‐brain natriuretic peptide in relation to inflammation, myocardial necrosis, and the effect of an invasive strategy in unstable coronary artery disease. Journal of the American College of Cardiology 2003;42(11):1909‐16. - PubMed
Kociol 2011 {published data only}
    1. Kociol RD, McNulty SE, Hernandez AF, Lee K L, Redfield MM, Tracy RP, et al. Markers of congestion, symptom relief and clinical outcomes among patients hospitalized with acute heart failure: Data from the diuretic optimal strategy evaluation in acute heart failure study. Journal of the American College of Cardiology 2011;Conference: 60th Annual Scientific Session of the American College of Cardiology and i2 Summit: Innovation in Intervention, ACC.11 New Orleans, LA United States. Conference Start: 20110402 Conference End: 20110405. Conference Publication::E220.
Koitabashi 2005 {published data only}
    1. Koitabashi T, Inomata T, Niwano S, Nishii M, Takeuchi I, Nakano H, et al. Distinguishable optimal levels of plasma B‐type natriuretic peptide in heart failure management based on complicated atrial fibrillation. International Heart Journal 2005;46(3):453‐64. - PubMed
Komajda 2006 {published data only}
    1. Komajda M. REVIVE II (randomized multicenter evaluation of intravenous levosimendan efficacy). Clinical Cardiology 2006;29:43.
Krackhardt 2008 {published data only}
    1. Krackhardt F, Duengen HD, Schlattmann P, Kehrt K, Hassfeldt S, Dietz R, et al. NT‐proBNP predicts long‐term risk of cardiac death in patients with dilative cardiomyopathy: A ten‐year follow‐up trial. Journal of the American College of Cardiology 2008;51(10):A249‐A.
Krackhardt 2011 {published data only}
    1. Krackhardt F, Dungen HD, Trippel TD, Inkrot S, Tscholl V, Schlattmann P, et al. N‐terminal pro‐B‐type natriuretic peptide and long‐term mortality in non‐ischaemic cardiomyopathy. Wiener Klinische Wochenschrift 2011;123(23‐24):738‐42. - PubMed
Ledwidge 2013 {published data only}
    1. Ledwidge M, Gallagher J, Conlon C, Tallon E, O'Connell E, Dawkins I, et al. Natriuretic peptide‐based screening and collaborative care for heart failure: The STOP‐HF randomised trial. JAMA 2013;310(1):66‐74. - PubMed
Leuchte 2005 {published data only}
    1. Leuchte HH, Holzapfel M, Neurohr C, Vogeser M, Behr J. Characterization of brain natriuretic peptide in long‐term follow‐up of pulmonary arterial hypertension. Chest 2005;128(4):2368‐74. - PubMed
Li 2007 {published data only}
    1. Li N, Li Y, Wang F, Jiang W, Huang J, Xu Z, et al. Does NT‐proBNP remain a sensitive biomarker for chronic heart failure after administration of a beta‐blocker?. Clinical Cardiology 2007;30(9):469‐74. - PMC - PubMed
Lindahl 2005 {published data only}
    1. Lindahl B, Lindback J, Jernberg T, Johnston N, Stridsberg M, Venge P, et al. Serial analyses of N‐terminal pro‐B‐type natriuretic peptide in patients with non‐ST‐segment elevation acute coronary syndromes ‐ A fragmin and fast revascularisation during instability in coronary artery disease (FRISC)‐II substudy. Journal of the American College of Cardiology 2005;45:533‐41. - PubMed
Luchner 2012 {published data only}
    1. Luchner A, Mockel M, Spanuth E, Mocks J, Peetz D, Baum H, et al. N‐terminal pro brain natriuretic peptide in the management of patients in the medical emergency department (PROMPT): correlation with disease severity, utilization of hospital resources, and prognosis in a large, prospective, randomized multicentre trial. European Journal of Heart Failure 2012;14:259‐67. - PubMed
Maisel 2013 {published data only}
    1. Maisel A, Barnard D, Jaski B, Frivold G, Marais J, Azer M, et al. Primary results of the HABIT Trial (heart failure assessment with BNP in the home). Journal of the American College of Cardiology 2013;61(16):1726‐35. - PubMed
McNairy 2002 {published data only}
    1. McNairy M, Gardetto N, Clopton P, Garcia A, Krishnaswamy P, Kazanegra R, et al. Stability of B‐type natriuretic peptide levels during exercise in patients with congestive heart failure: implications for outpatient monitoring with B‐type natriuretic peptide. American Heart Journal 2002;143(3):406‐11. - PubMed
Miller 2009 {published data only}
    1. Miller WL, Hartman KA, Hodge DO, Hartman S, Struck J, Morgenthaler NG, et al. Response of novel biomarkers to BNP infusion in patients with decompensated heart failure: a multimarker paradigm. Journal of Cardiovascular Translational Research 2009;2(4):526‐35. - PubMed
Murdoch 1999 {published data only}
    1. Murdoch DR, McDonagh TA, Byrne J, Blue L, Farmer R, Morton JJ, et al. Titration of vasodilator therapy in chronic heart failure according to plasma brain natriuretic peptide concentration: randomised comparison of the haemodynamic and neuroendocrine effects of tailored versus empirical therapy. Amercian Heart Journal 1999;138(6):1126‐32. - PubMed
NCT00206856 {unpublished data only}
    1. NCT00206856. Rapid Assessment of Bedside BNP In Treatment of Heart Failure (RABBIT). clinicaltrials.gov/ct2/show/NCT00206856 (accessed 16 December 2014).
NCT00622531 {unpublished data only}
    1. NCT00622531. Serial BNP Testing for heart failure management (USE‐BNP). clinicaltrials.gov/ct2/show/NCT00622531?term=NCT00622531&rank=1 (accessed 16 December 2014).
NCT01299350 {unpublished data only}
    1. NCT01299350. Nt‐proBNP versus clinical guided discharge in acute heart failure. clinicaltrials.gov/ct2/show/NCT01299350 (accessed 16 December 2014).
Pascual‐Figal 2008 {published data only}
    1. Pascual‐Figal DA, Domingo M, Casas T, Gich I, Ordonez‐Llanos J, Martinez P, et al. Usefulness of clinical and NT‐proBNP monitoring for prognostic guidance in destabilized heart failure outpatients. European Heart Journal 2008;29(8):1011‐8. - PubMed
Tang 2005 {published data only}
    1. Tang WHW, Francis GS. The difficult task of evaluating how to monitor patients with heart failure. Journal of Cardiac Failure 2005;11(6):422‐4. - PubMed
Troughton 2004 {published data only}
    1. Troughton RW, Richards AM, Yandle TG, Nicholls G. Routine measurement of natriuretic peptide to guide the diagnosis and management of chronic heart failure. Circulation 2004;109(25):e325‐6; author reply e‐6. - PubMed
Valle 2008 {published data only}
    1. Valle R, Aspromonte N, Giovinazzo P, Carbonieri E, Chiatto M, Tano G, et al. B‐type natriuretic Peptide‐guided treatment for predicting outcome in patients hospitalized in sub‐intensive care unit with acute heart failure. Journal of Cardiac Failure 2008;14(3):219‐24. - PubMed
Wasywich 2009 {published data only}
    1. Wasywich CA, Whalley GA, Walsh HA, Gamble GD, Doughty RN. Changes in tissue‐Doppler echocardiographic assessment of left ventricular filling during NT‐proBNP guided heart failure treatment titration: a pilot study. Heart, Lung & Circulation 2009;18(1):38‐44. - PubMed

References to ongoing studies

Felker 2014 {published data only}
    1. Felker GM, Ahmad T, Anstrom KJ, Adams KF, Cooper LS, Ezekowitz JA, et al. Rationale and design of the GUIDE‐IT study: Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure. JACC Heart Failure 2014;2(5):457‐65. - PMC - PubMed
Jourdain 2014 {published data only}
    1. NCT02110433. Heart Failure Educational and Follow up Platform (HELP). https://clinicaltrials.gov/ct2/show/NCT02110433 (accessed 28 January 2016).
Metra 2012 {published data only}
    1. Metra M, Pagani F, Lazzarini V, Bettari L, Bonetti G, Bugatti S, et al. Acute heart failure (AHF) is associated with poor prognosis. Giornale Italiano di Cardiologia 2011;Conference: 72 Congresso Nazionale Della Societa Italiana di Cardiologia Rome Italy. Conference Start: 20111210 Conference End: 20111212. Conference Publication:(Conference: 72 Congresso Nazionale Della Societa Italiana di Cardiologia Rome Italy. Conference Start: 20111210 Conference End: 20111212. Conference Publication:):e37.
Moe 2007 {published data only}
    1. NCT00601679. Improvement in Clinical Outcomes of Patients With Chronic Heart Failure Using Serial NT‐proBNP Monitoring: The EX‐IMPROVE‐CHF Study. http://clinicaltrials.gov/ct2/results?term=eximprovechf (accessed 16 December 2014).
Saraya 2015 {published data only}
    1. Saraya M, Kassem H, Salah Eldin H. Adding brain natriuretic peptide, ultrasound lung comets or tissue Doppler to clinical guidance in reducing heart failure hospitalisation. European Heart Journal. 2015; Vol. 36:504.
Steinen 2014 {published data only}
    1. Stienen S, Salah K, Moons AH, Bakx AL, Pol PE, Schroeder‐Tanka JM, et al. Rationale and design of PRIMA II: A multicenter, randomized clinical trial to study the impact of in‐hospital guidance for acute decompensated heart failure treatment by a predefined NT‐PRoBNP target on the reduction of readmIssion and Mortality rAtes. American Heart Journal 2014;168(1):30‐6. - PubMed

Additional references

Atisha 2004
    1. Atisha D, Bhalla MA, Morrison LK, Felicio L, Clopton P, Gardetto N, et al. A prospective study in search of an optimal B‐natriuretic peptide level to screen patients for cardiac dysfunction. American Heart Journal 2004;148(3):518‐23. - PubMed
Balion 2014
    1. Balion C, McKelvie R, Don‐Wauchope AC, Santaguida PL, Oremus M, Keshavarz H, et al. B‐type natriuretic peptide‐guided therapy: a systematic review. Heart Failure Review 2014;19:553‐64. - PubMed
Chen 2010
    1. Chen WC, Tran KD, Maisel AS. Biomarkers in heart failure. Heart 2010;96(4):314‐20. - PubMed
Clerico 2007
    1. Clerico A, Fontana M, Zyw L, Passino C, Emdin M. Comparison of the diagnostic accuracy of brain natriuretic peptide (BNP) and the N‐terminal part of the propeptide of BNP immunoassays in chronic and acute heart failure: a systematic review. Clinical Chemistry 2007;53(5):813‐22. [PUBMED: 17384013] - PubMed
De Beradinis 2012
    1. DeBeradinis B, Januzzi JL. Use of biomarkers to guide outpatient therapy of heart failure. Current Opinion Cardiology 2012;27:661‐8. - PubMed
De Vecchis 2013a
    1. Vecchis R, Esposito C, Cantatrione S. Natriuretic peptide‐guided therapy. Herz 2013;38:618‐28. - PubMed
De Vecchis 2014
    1. Vecchis R, Esposito C, Biase G, Ariano C, Giasi A, Cioppa C. B‐type natriuretic peptide‐guided versus symptom‐guided therapy in outpatients with chronic heart failure: a systematic review with meta‐analysis. Journal of Cardiovascular Medicine 2014;15(2):122‐34. - PubMed
Doust 2005
    1. Doust JA, Pietrzak E, Dobson A, Glasziou P. How well does B‐type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review. BMJ (Clinical research ed.) 2005;330(7492):625. [PUBMED: 15774989] - PMC - PubMed
Felker 2009
    1. Felker GM, Hasselblad V, Hernandez AF, O’Connor CM. Biomarker‐guided therapy in chronic heart failure:A meta‐analysis of randomised controlled trials. American Heart Journal 2009;158:422‐30. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011, Available from www.cochrane‐handbook.org.
Ichiki 2013
    1. Ichiki T, Huntley BK, Burnett JC. BNP molecular forms and processing by the cardiac serine protease corin. Advances in Clinical Chemistry 2013;61:1‐31. - PMC - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011, Available from www.cochrane‐handbook.org.
Li 2013
    1. Li P, Luo Y, Chen Y. B‐type natriuretic peptide‐guided chronic heart failure therapy: a meta‐analysis of 11 randomised controlled trials. Heart, Lung and Circulation 2013;22(10):852‐60. - PubMed
Li 2014
    1. Li Y, Pei H, Zhou X, Wu Y. Efficacy, modifiable factors to efficacy, safety of B‐type natriuretic peptide‐guided heart failure therapy: A meta‐analysis. Cardiology (Switzerland). 2014:66.
McMurray 2012
    1. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European Heart Journal 2012;33(14):1797‐847. - PubMed
NICE 2010
    1. National Clincial Guideline Collaborating Centre. Chronic heart failure: management of chronic heart failure in adults in primary and secondary care. http://www.nice.org.uk/CG108 (accessed 25 June 2010).
NICE 2014
    1. National Clincial Guideline Collaborating Centre. Acute heart failure: diagnosis and management. https://www.nice.org.uk/guidance/cg187 (accessed 17 Feb 2016).
Owan 2006
    1. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. New England Journal of Medicine 2006;355(3):251‐9. - PubMed
Porapakkham 2010
    1. Porapakkham P, Porapakkham P, Zimmet H, Billah B, Krum H. B‐Type natriuretic peptide‐guided heart failure therapy: A meta‐analysis. Archives of Internal Medicine 2010;170(6):507‐14. - PubMed
Richards 2012
    1. Richards AM, Troughton RW. Use of natriuretic peptides to guide and monitor heart failure therapy. Clinical Chemistry 2012;58(1):62‐71. - PubMed
Savarese 2013
    1. Savarese G, Trimarco B, Dellegrottaglie S, Prastaro M, Gambardella F, Rengo G, et al. Natriuretic peptide‐guided therapy in chronic heart failure: a meta‐analysis of 2,686 patients in 12randomized trials. PLoS One 2013;8(3):e96706. - PMC - PubMed
Troughton 2014
    1. Troughton RW, Frampton CM, Brunner‐La Rocca HP, Pfisterer M, Eurlings LWM, Erntell H, et al. Effect of B‐type natriuretic peptide‐guided treatment of chronic heart failure on total mortality and hospitalisation: an individual patient meta‐analysis. European Heart Journal 2014;35:1559‐67. - PMC - PubMed
Xin 2015
    1. Xin W, Lin Z, Mi S. Does B‐type natriuretic peptide‐guided therapy improve outcomes in patients with chronic heart failure? A systematic review and meta‐analysis of randomised controlled trials. Heart Failure Review 2015;20:69‐80. - PubMed

References to other published versions of this review

Kearley 2011
    1. Kearley KE, Wright FL, Tyndel S, Roberts NW, Perera R, Glasziou PP, et al. B‐type natriuretic peptide‐guided treatment for heart failure. Cochrane Database of Systematic Reviews 2011, Issue 1. [DOI: 10.1002/14651858.CD008966] - DOI - PMC - PubMed

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