Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis

Richard W. Troughton*, Christopher M. Frampton, Hans-Peter Brunner-La Rocca, Matthias Pfisterer, Luc W. M. Eurlings, Hans Erntell, Hans Persson, Christopher M. O'Connor, Deddo Moertl, Patric Karlstrom, Ulf Dahlstrom, Hanna K. Gaggin, James L. Januzzi, Rudolf Berger, A. Mark Richards, Yigal M. Pinto, M. Gary Nicholls

*Corresponding author for this work

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Abstract

Aims 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. Methods and results ligible 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%) 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. Conclusion Natriuretic peptide-guided treatment of heart failure reduces all-cause mortality in patients aged <75 years and overall reduces heart failure and cardiovascular hospitalization.
Original languageEnglish
Pages (from-to)1559-1567
JournalEuropean Heart Journal
Volume35
Issue number23
DOIs
Publication statusPublished - Jun 2014

Keywords

  • Natriuretic peptides
  • B-type Natriuretic peptide
  • Heart failure

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