title: Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis.
abstract: OBJECTIVE
  Natriuretic peptide-guided (NP-guided) treatment of heart failure has been tested against standard clinically guided care in multiple studies, but findings have been limited by study size. We sought to perform an individual patient data meta-analysis to evaluate the effect of NP-guided treatment of heart failure on all-cause mortality.
  
  
  RESULTS
  Eligible randomized clinical trials were identified from searches of Medline and EMBASE databases and the Cochrane Clinical Trials Register. The primary pre-specified outcome, all-cause mortality was tested using a Cox proportional hazards regression model that included study of origin, age (<75 or ≥75 years), and left ventricular ejection fraction (LVEF, ≤45 or >45%) as covariates. Secondary endpoints included heart failure or cardiovascular hospitalization. Of 11 eligible studies, 9 provided individual patient data and 2 aggregate data. For the primary endpoint individual data from 2000 patients were included, 994 randomized to clinically guided care and 1006 to NP-guided care. All-cause mortality was significantly reduced by NP-guided treatment [hazard ratio = 0.62 (0.45-0.86); P = 0.004] with no heterogeneity between studies or interaction with LVEF. The survival benefit from NP-guided therapy was seen in younger (<75 years) patients [0.62 (0.45-0.85); P = 0.004] but not older (≥75 years) patients [0.98 (0.75-1.27); P = 0.96]. Hospitalization due to heart failure [0.80 (0.67-0.94); P = 0.009] or cardiovascular disease [0.82 (0.67-0.99); P = 0.048] was significantly lower in NP-guided patients with no heterogeneity between studies and no interaction with age or LVEF.
  
  
  CONCLUSIONS
  Natriuretic peptide-guided treatment of heart failure reduces all-cause mortality in patients aged <75 years and overall reduces heart failure and cardiovascular hospitalization.
authors.affiliation: Department of Medicine, University of Otago Christchurch, Christchurch Hospital, PO Box 4345, Christchurch 8140, New Zealand richard.troughton@cdhb.health.nz.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Troughton
authors.affiliation: Department of Medicine, University of Otago Christchurch, Christchurch Hospital, PO Box 4345, Christchurch 8140, New Zealand.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Frampton
authors.affiliation: Department of Cardiology Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Pfisterer
authors.affiliation: Department of Cardiology Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Luc W M
authors.initials: LW
authors.lastname: Eurlings
authors.affiliation: Department of Clinical Sciences, Karolinska Instutet, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Erntell
authors.affiliation: Department of Clinical Sciences, Karolinska Instutet, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Persson
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Department of Cardiology, LKH, St Poelten, Austria.
authors.forename: Deddo
authors.initials: D
authors.lastname: Moertl
authors.affiliation: Division of Cardiology, Department of Medicine, County Hospital Ryhov, Jonkoping, Sweden.
authors.forename: Patric
authors.initials: P
authors.lastname: Karlström
authors.affiliation: Department of Medical and Health Sciences, Linkoping University, Department of Cardiology, County Council of Ostergotland, Linkoping, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Dahlström
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Hanna K
authors.initials: HK
authors.lastname: Gaggin
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Berger
authors.affiliation: Department of Medicine, University of Otago Christchurch, Christchurch Hospital, PO Box 4345, Christchurch 8140, New Zealand National University Heart Centre Singapore, Singapore.
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Yigal M
authors.initials: YM
authors.lastname: Pinto
authors.affiliation: Department of Medicine, University of Otago Christchurch, Christchurch Hospital, PO Box 4345, Christchurch 8140, New Zealand.
authors.forename: M Gary
authors.initials: MG
authors.lastname: Nicholls
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism; D002908:Chronic Disease; D057915:Drug Substitution / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D016032:Randomized Controlled Trials as Topic; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000401:mortality / Q000628:therapy
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D049994:Sodium Potassium Chloride Symporter Inhibitors; D020097:Natriuretic Peptide, Brain
keywords: B-type Natriuretic peptide; Heart failure; Natriuretic peptides