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Measurement of plasma levels of brain natriuretic peptide (BNP) to guide treatment of patients with chronic heart failure (HF) has been investigated in several randomized controlled trials (RCTs). The aim of this study was to examine the overall effect of BNP-guided therapy on cardiovascular outcomes in patients with chronic HF.
We searched MEDLINE, EMBASE, Cochrane databases, and conference proceedings for RCTs from January 2001 to August 2012. Studies were included if they compared BNP-guided therapy vs. standard care in patients with chronic HF. The pooled effects were calculated using fixed-effects model (Mantel-Haenszel method).
Eight RCTs with a total of 2,056 patients (1,037 BNP-guided and 1,019 standard care) were included in this study. Mean follow-up duration for each study ranged from 9 to 24 months. Overall, there was a significantly lower risk of all-cause mortality (risk ratio [RR] 0.81, 95% confidence interval [CI] 0.68 to 0.97, p=0.02) in the BNP-guided therapy group compared with the standard care group. BNP-guided HF therapy was also associated with a significantly lower rate of hospital admission for various causes (RR 0.81, 95% CI 0.72 to 0.91, p<0.001). Stratified analysis of our study showed that the benefit of biomarker-guidance was more pronounced in multicenter trials compared to single center studies, studies using NT-proBNP instead of BNP, and studies with follow-up duration >12 months compared with studies with shorter follow-up.
BNP-guided therapy is associated with significant reductions in all-cause mortality and hospital admission compared with standard care 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: 1264-295
- 2013 American College of Cardiology Foundation