Effect of B-Type Natriuretic Peptide-Guided Treatment of Chronic Heart Failure on Total Mortality and Hospitalization: An Individual Patient Meta-Analysis
What is the effect of natriuretic peptide (NP)-guided treatment of heart failure (HF) on all-cause mortality?
The investigators conducted an individual patient data meta-analysis of 11 eligible randomized clinical trials (of which nine provided individual patient data and two aggregate data). Using a Cox proportional hazards regression model that included study of origin, age (<75 or ≥75 years), and left ventricular ejection fraction (LVEF; ≤45 or >45%) as covariates, they tested all-cause mortality as the primary prespecified outcome and heart failure or cardiovascular hospitalization as secondary endpoints.
The study cohort was comprised of 2,000 patients including 994 randomized to clinically guided care and 1,006 to NP-guided care. The investigators found that NP-guided treatment significantly reduced all-cause mortality (hazard ratio [HR], 0.62; 95% confidence interval [CI], 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) individuals (HR, 0.62; 95% CI, 0.45-0.85; p = 0.004), but not older (≥75 years) patients (HR, 0.98; 95% CI, 0.75-1.27; p = 0.96). Hospitalization due to HF (HR, 0.80; 95% CI, 0.67-0.94; p = 0.009) or cardiovascular disease (HR, 0.82; 95% CI, 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.
The study investigators concluded that NP-guided therapy of HF reduces all-cause mortality in patients ages <75 years, and overall reduces HF and cardiovascular hospitalization.
This is an important study because it suggests that biomarker-guided care of HF patients should substantially reduce mortality and hospitalizations, particularly in younger individuals, and thereby should significantly reduce the economic burden of HF. Prospective studies, possibly pursuing a multimarker strategy to guide HF therapy, are now urgently needed to confirm these important findings.
Keywords: Proportional Hazards Models, Heart Failure, Hospitalization, Natriuretic Peptide, Brain
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