Natriuretic peptide-guided treatment for heart failure: a systematic review and meta-analysis
<p>Background: GUIDE-IT, the largest trial to date, published in August 2017, evaluating the effectiveness of natriuretic peptide-guided treatment of heart failure, was stopped early for futility on a composite outcome. However, the reported effect sizes on individual outcomes of all-cause m...
| Asıl Yazarlar: | , , , , , |
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| Materyal Türü: | Journal article |
| Dil: | English |
| Baskı/Yayın Bilgisi: |
BMJ
2019
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| _version_ | 1826264770700902400 |
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| author | McLellan, J Bankhead, C Oke, J Hobbs, R Taylor, C Perera-Salazar, R |
| author_facet | McLellan, J Bankhead, C Oke, J Hobbs, R Taylor, C Perera-Salazar, R |
| author_sort | McLellan, J |
| collection | OXFORD |
| description | <p>Background: GUIDE-IT, the largest trial to date, published in August 2017, evaluating the effectiveness of natriuretic peptide-guided treatment of heart failure, was stopped early for futility on a composite outcome. However, the reported effect sizes on individual outcomes of all-cause mortality and heart failure admissions are potentially clinically relevant.</p> <p>Objective: This systematic review and meta-analysis aims to combine all available trial level evidence to determine if natriuretic peptide-guided treatment of heart failure reduces all-cause mortality and heart failure admissions in patients with heart failure.</p> <p>Study selection: Eight databases, no language restrictions, to November 2017 were searched for all randomised controlled trials comparing natriuretic peptide-guided treatment versus clinical assessment alone in adult patients with heart failure. No language restrictions were applied. Publications were independently double screened and extracted. Fixed-effect meta-analyses were conducted.</p> <p>Findings: 89 papers were included, reporting 19 trials (4554 participants), average ages 62-80 years. Pooled risk ratio estimates for all-cause mortality (16 trials, 4063 participants), were 0.87, 95% confidence interval 0.77 to 0.99, and 0.80, 95% CI 0.72 to 0.89, for heart failure admissions (11 trials, 2822 participants). Sensitivity analyses, restricted to low risk of bias, produced similar estimates, but were no longer statistically significant.</p> <p>Conclusions: Considering all the evidence to date, the pooled effects suggest that NP-guided treatment is beneficial in reducing heart failure admissions and all-cause mortality. However, there is still insufficient high quality evidence to make definitive recommendations on the use of natriuretic peptide-guided treatment in clinical practice.</p> |
| first_indexed | 2024-03-06T20:13:12Z |
| format | Journal article |
| id | oxford-uuid:2b474756-014f-4526-a082-88a2f7821cbc |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T20:13:12Z |
| publishDate | 2019 |
| publisher | BMJ |
| record_format | dspace |
| spelling | oxford-uuid:2b474756-014f-4526-a082-88a2f7821cbc2022-03-26T12:29:58ZNatriuretic peptide-guided treatment for heart failure: a systematic review and meta-analysisJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:2b474756-014f-4526-a082-88a2f7821cbcEnglishSymplectic Elements at OxfordBMJ2019McLellan, JBankhead, COke, JHobbs, RTaylor, CPerera-Salazar, R <p>Background: GUIDE-IT, the largest trial to date, published in August 2017, evaluating the effectiveness of natriuretic peptide-guided treatment of heart failure, was stopped early for futility on a composite outcome. However, the reported effect sizes on individual outcomes of all-cause mortality and heart failure admissions are potentially clinically relevant.</p> <p>Objective: This systematic review and meta-analysis aims to combine all available trial level evidence to determine if natriuretic peptide-guided treatment of heart failure reduces all-cause mortality and heart failure admissions in patients with heart failure.</p> <p>Study selection: Eight databases, no language restrictions, to November 2017 were searched for all randomised controlled trials comparing natriuretic peptide-guided treatment versus clinical assessment alone in adult patients with heart failure. No language restrictions were applied. Publications were independently double screened and extracted. Fixed-effect meta-analyses were conducted.</p> <p>Findings: 89 papers were included, reporting 19 trials (4554 participants), average ages 62-80 years. Pooled risk ratio estimates for all-cause mortality (16 trials, 4063 participants), were 0.87, 95% confidence interval 0.77 to 0.99, and 0.80, 95% CI 0.72 to 0.89, for heart failure admissions (11 trials, 2822 participants). Sensitivity analyses, restricted to low risk of bias, produced similar estimates, but were no longer statistically significant.</p> <p>Conclusions: Considering all the evidence to date, the pooled effects suggest that NP-guided treatment is beneficial in reducing heart failure admissions and all-cause mortality. However, there is still insufficient high quality evidence to make definitive recommendations on the use of natriuretic peptide-guided treatment in clinical practice.</p> |
| spellingShingle | McLellan, J Bankhead, C Oke, J Hobbs, R Taylor, C Perera-Salazar, R Natriuretic peptide-guided treatment for heart failure: a systematic review and meta-analysis |
| title | Natriuretic peptide-guided treatment for heart failure: a systematic review and meta-analysis |
| title_full | Natriuretic peptide-guided treatment for heart failure: a systematic review and meta-analysis |
| title_fullStr | Natriuretic peptide-guided treatment for heart failure: a systematic review and meta-analysis |
| title_full_unstemmed | Natriuretic peptide-guided treatment for heart failure: a systematic review and meta-analysis |
| title_short | Natriuretic peptide-guided treatment for heart failure: a systematic review and meta-analysis |
| title_sort | natriuretic peptide guided treatment for heart failure a systematic review and meta analysis |
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