title: B-type natriuretic peptide-guided therapy: a systematic review.
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.
authors: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
authors: Cynthia
authors: C
authors: Balion
authors: Robert
authors: R
authors: McKelvie
authors: Andrew C
authors: AC
authors: Don-Wauchope
authors: Pasqualina L
authors: PL
authors: Santaguida
authors: Mark
authors: M
authors: Oremus
authors: Homa
authors: H
authors: Keshavarz
authors: Stephen A
authors: SA
authors: Hill
authors: Ronald A
authors: RA
authors: Booth
authors: Usman
authors: U
authors: Ali
authors: Judy A
authors: JA
authors: Brown
authors: Amy
authors: A
authors: Bustamam
authors: Nazmul
authors: N
authors: Sohel
authors: Parminder
authors: P
authors: Raina
mesh_terms: D019468:Disease Management; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D020097:Natriuretic Peptide, Brain