Author + information
- Gianluigi Savarese,
- Maria Prastaro,
- Giuseppe Rengo,
- Dario Leosco,
- Bruno Trimarco and
- Pasquale Perrone-Filardi
The role of cardiac natriuretic peptides in the management of patients with chronic heart failure (HF) remains uncertain. The purpose of this study was to evaluate whether natriuretic peptide-guided therapy, compared to clinically-guided therapy, improves mortality and hospitalization rate in patients with chronic HF.
MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases were searched for articles reporting natriuretic peptide-guided therapy in HF until August 2012. All randomized trials reporting clinical end-points (all-cause mortality and/or HF hospitalization and/or all-cause hospitalization) were included. Meta-analysis was performed to assess the influence of treatment on outcomes.
13 trials enrolling 2,876 participants were included. Natriuretic peptide-guided therapy (either B-type natriuretic peptide [BNP]- or N-terminal pro-B-type natriuretic peptide [NT-proBNP]-guided therapy) significantly reduced all-cause mortality (Odds Ratio [OR]:0.71; 95% Confidence Interval [CI]:0.58 to 0.88; p=0.001), HF hospitalization (OR:0.53; CI:0.39 to 0.72; p=0.00) and all-cause hospitalization (OR:0.77; CI:0.61 to 0.96; p=0.02). When separately assessed, NT-proBNP-guided therapy significantly reduced all-cause mortality (OR:0.69; CI:0.55 to 0.87; p=0.00) and HF hospitalization (OR:0.50; CI:0.34 to 0.73; p=0.00), but not all-cause hospitalization (OR:0.71; CI:0.44 to 1.14; p=0.15), whereas BNP-guided therapy did not significantly reduce all-cause mortality (OR:0.81; 95% CI:0.52 to 1.28; p=0.37), HF hospitalization (OR:0.60; CI:0.30 to 1.18; p=0.14) or all-cause hospitalization (OR:0.73; 95% CI:0.61 to 0.96; p=0.08). Separate analyses on patients younger or older than 75 years reported that composite outcome of all-cause mortality and HF hospitalization was significantly reduced by natriuretic peptide-guided therapy in younger patients (OR:0.45; 95% CI:0.21 to 0.97; p=0.04), but not in older patients (OR:0.80; 95% CI:0.42 to 1.51; p=0.49).
Use of cardiac peptides to guide pharmacologic therapy significantly reduces mortality and morbidity in patients with chronic HF.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Targeting Heart Failure Therapy: Pharmacogenetics and Biomarkers
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1264-293
- 2013 American College of Cardiology Foundation