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B-type natriuretic peptide-guided therapy: a systematic review

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Abstract

BNP/NT-proBNP measurement has not gained widespread use for the management of patients with heart failure (HF) despite several randomized controlled trials. A systematic review addressing the question of whether patients with HF benefit from BNP-assisted therapy or intensified therapy compared with usual care was undertaken. Relevant randomized controlled trial (RCTs) were selected by searching Medline, Embase, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL for English-language articles published from 1980 to 2012. Selected studies required patients to be treated for chronic HF with medical therapy based on BNP/NT-proBNP or usual care. There were no restrictions except that BNP/NT-proBNP measurement had to be done by an FDA approved method. Nine RCTs were identified with 2,104 patients with study duration that ranged from 3 to 18 months. Overall, there was a wide variation in study design and how parameters were reported including patient selection, baseline characteristics, therapy goals, BNP/NT-proBNP cutpoint, and outcome types. Meta-analysis was not appropriate given this study heterogeneity. The strength of evidence for the outcome of mortality, reported in seven studies, was found to be low due to inconsistency and imprecision. This systematic review showed that the evidence is of low quality and insufficient to support the use of BNP/NT-proBNP to guide HF therapy. Further trials with improved design are needed.

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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

Cynthia Balion, Robert McKelvie, Pasqualina L. Santaguida, Mark Oremus, Homa Keshavarz, Stephen Hill, Usman Ali, 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 Panel of the Canadian Agency for Drug and Technology in Health (CADTH).

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Authors and Affiliations

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

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

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

    Robert McKelvie

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

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

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

    Ronald A. Booth

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  1. Cynthia Balion
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Correspondence to Parminder Raina.

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Balion, C., McKelvie, R., Don-Wauchope, A.C. et al. B-type natriuretic peptide-guided therapy: a systematic review. Heart Fail Rev 19, 553–564 (2014). https://doi.org/10.1007/s10741-014-9451-x

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