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Incremental predictive value of natriuretic peptides for prognosis in the chronic stable heart failure population: a systematic review

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Abstract

The aim of this study was to determine whether measurement of natriuretic peptides independently adds incremental predictive value for mortality and morbidity in patients with chronic stable heart failure (CSHF). We electronically searched Medline®, Embase™, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL 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 methodological quality. Data were extracted on study design, population demographics, assay cutpoints, prognostic risk prediction model covariates, statistical methods, outcomes, and results. One hundred and eighty-three studies were identified as prognostic in the systematic review. From these, 15 studies (all NT-proBNP) considered incremental predictive value in CSHF subjects. Follow-up varied from 12 to 37 months. All studies presented at least one estimate of incremental predictive value of NT-proBNP relative to the base prognostic model. Using discrimination or likelihood statistics, these studies consistently showed that NT-proBNP increased model performance. Three studies used re-classification and model validation computations to establish incremental predictive value; these studies showed less consistency with respect to added value. Although there were differences in the base risk prediction models, assay cutpoints, and lengths of follow-up, there was consistency in NT-proBNP adding incremental predictive value for prognostic models in chronic stable CSHF patients. The limitations in the literature suggest that studies designed to evaluate prognostic models should be undertaken to evaluate the incremental value of natriuretic peptide as a predictor of mortality and morbidity in CSHF.

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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 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, Mark Oremus, Usman Ali, Judy A. Brown, 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. Mark Oremus
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Correspondence to Parminder Raina.

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Don-Wauchope, A.C., Santaguida, P.L., Oremus, M. et al. Incremental predictive value of natriuretic peptides for prognosis in the chronic stable heart failure population: a systematic review. Heart Fail Rev 19, 521–540 (2014). https://doi.org/10.1007/s10741-014-9443-x

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  • DOI: https://doi.org/10.1007/s10741-014-9443-x

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