Meta-analysis on BNP-guided therapy for heart failure in ambulatory care

January 01, 0001

Meta-analysis on BNP-guided therapy for heart failure in ambulatory care

The use of plasma levels of B-type natriuretic peptides (BNPs) to guide treatment of patients with chronic heart failure (HF) has been investigated in a number of randomized controlled trials (RCTs). These Australian authors performed a meta-analysis to examine the overall effect of BNP-guided drug therapy on cardiovascular outcomes in patients with chronic HF. They included RCTs that enrolled more than 20 patients and involved comparison of BNP-guided drug therapy vs usual clinical care of the patient with chronic HF in an outpatient setting.

They found: "Eight RCTs with a total of 1726 patients and with a mean duration of 16 months (range, 3-24 months) were included in the meta-analysis. Overall, there was a significantly lower risk of all-cause mortality (RR 0.76) in the BNP-guided therapy group compared with the control group. In the subgroup of patients younger than 75 years, all-cause mortality was also significantly lower in the BNP-guided group (RR 0.52;). However, there was no reduction in mortality with BNP-guided therapy in patients 75 years or older (RR 0.94). The risk of all-cause hospitalization and survival free of any hospitalization was not significantly different between groups (RR 0.82, and RR 1.07, respectively). The additional percentage of patients achieving target doses of angiotensin-converting enzyme inhibitors and beta-blockers during the course of these trials averaged 21% and 22% in the BNP group and 11.7% and 12.5% in the control group, respectively."

The authors concluded: "B-type natriuretic peptide-guided therapy reduces all-cause mortality in patients with chronic HF compared with usual clinical care, especially in patients younger than 75 years. A component of this survival benefit may be due to increased use of agents proven to decrease mortality in chronic HF. However, there does not seem to be a reduction in all- cause hospitalization or an increase in survival free of hospitalization using this approach."

This evidence strongly supports use of BNP to guide therapy in primary care practice.


For the full abstract, click here.

Arch Intern Med 170(6):507-514, 22 March 2010 © 2010 to the American Medical Association
B-Type Natriuretic Peptide-Guided Heart Failure Therapy-A Meta-analysis. Pramote Porapakkham, Pornwalee Porapakkham, Hendrik Zimmet, Baki Billah, Henry Krum.

Category: K. Circulatory. Keywords: B-type natriuretic peptide, BNP, heart failure, therapy, all-cause mortality, hospitalization, meta-analysis of randomized controlled trials, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 9 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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