Incremental value of natriuretic peptide measurement in acute decompensated heart failure (ADHF): a systematic review
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The aim of this systematic review was to determine whether B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) independently add incremental value for predicting mortality and morbidity in patients with acute decompensated heart failure (ADHF). Medline®, Embase™, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL were searched from 1989 to June 2012. We also searched reference lists of included articles, systematic reviews, and the gray literature. Studies were screened for eligibility criteria and assessed for risk of bias. Data were extracted on study design, population demographics, assay cutpoints, prognostic risk prediction model covariates, statistical methods, outcomes, and results. From 183 citations, only seven studies (5 BNP and 2 NT-proBNP) considered incremental value in ADHF subjects admitted to acute care centers. Admission assay levels and length of follow-up varied for BNP studies (31 days to 12 months) and for NT-proBNP studies (25–82 months). All studies presented at least one estimate of incremental value of BNP/NT-proBNP relative to the base prognostic model. Using discrimination or likelihood statistics, these studies consistently showed that BNP or NT-proBNP increased model performance. Three studies used reclassification and model validation computations to establish incremental value; these studies showed less consistency with respect to added value. In conclusion, the literature assessing incremental value of BNP/NT-proBNP in ADHF populations is limited to seven studies evaluating only mortality outcomes and at moderate risk of bias. Although there were differences in the base risk prediction models, assay cutpoints, and lengths of follow-up, there was consistency in BNP/NT-proBNP adding incremental value in prediction models in ADHF patients.
KeywordsBNP NT-proBNP Acute decompensated heart failure Incremental prognostic value Prognosis Systematic review
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 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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