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Prediction of clinical outcomes using B-type natriuretic peptides in the general population: a systematic review

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Abstract

The use of B-type natriuretic peptides to predict outcomes in general populations has been investigated in a number of primary studies. A previous systematic review considering natriuretic peptides in cardiovascular disease included a subgroup of general population studies, which suggested an association with a number of clinical outcomes. We electronically searched Medline, Embase, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL for English-language articles published between 1989 and mid-2012. We utilized trained reviewers and standardized forms to screen articles for inclusion and extract data from included articles. All included studies (n = 7) were summarized in narrative and tabular form. A general population was defined as one that was randomly selected from a community setting where no specific inclusion or exclusion criteria were specified. The seven included studies all used FDA approved assays for NT-proBNP. The range of clinical outcomes and heterogeneity did not allow for meta-analysis. The hazard ratios for predicting outcomes in the included studies ranged from 1.0 to 4.1 (all p values <0.05). The discrimination statistics reported in four studies all demonstrated statistically significant improvements in predicting outcomes. NT-proBNP is associated with heart failure, all-cause and cardiovascular mortality, and other combined cardiovascular events in a general unselected population. The discrimination statistics suggest modest improvements in risk stratification. No prospective studies exist to demonstrate the clinical utility of using B-type natriuretic peptides to predict clinical outcomes in a general population.

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Acknowledgments

This manuscript is based on research conducted by the McMaster Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290 2007-10060-I). The findings and conclusions in this paper are those of the authors, who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality. No statement herein should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services. Parminder Raina holds a Tier 1 Canada Research Chair in Geroscience and the Raymond and Margaret Labarge Chair in Research and Knowledge Application for Optimal Aging.

Conflict of interest

Mark Oremus, Robert McKelvie, Pasqualina L. Santaguida, Usman Ali, Cynthia Balion, Stephen A. Hill, Judy A. Brown, Amy Bustamam, Nazmul Sohel, and Parminder Raina have no conflicts of interest or financial ties to disclose. Andrew C. Don-Wauchope has received clinical trial support from AMGEN. Ronald A. Booth has received honoraria from INOVA Diagnostics Inc. and is a member of the Health Technology Expert Review Panel of the Canadian Agency for Drugs and Technologies in Health (CADTH).

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Authors and Affiliations

  1. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada

    Andrew C. Don-Wauchope, Stephen A. Hill & Cynthia Balion

  2. Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, MIP Suite 309A, Hamilton, ON, L8S 4K1, Canada

    Pasqualina L. Santaguida, Judy A. Brown, Mark Oremus, Usman Ali, Amy Bustamam, Nazmul Sohel & Parminder Raina

  3. Department of Medicine, McMaster University, Hamilton, ON, Canada

    Robert McKelvie

  4. Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada

    Ronald A. Booth

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  1. Andrew C. Don-Wauchope
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  2. Pasqualina L. Santaguida
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  3. Robert McKelvie
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  4. Judy A. Brown
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  5. Mark Oremus
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  7. Amy Bustamam
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  8. Nazmul Sohel
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  9. Stephen A. Hill
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  11. Cynthia Balion
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  12. Parminder Raina
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Correspondence to Parminder Raina.

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Don-Wauchope, A.C., Santaguida, P.L., McKelvie, R. et al. Prediction of clinical outcomes using B-type natriuretic peptides in the general population: a systematic review. Heart Fail Rev 19, 541–551 (2014). https://doi.org/10.1007/s10741-014-9446-7

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