Effect of B-Type Natriuretic Peptide-Guided Treatment of Chronic Heart Failure on Total Mortality and Hospitalization: An Individual Patient Meta-Analysis

Mar 14, 2014
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Authors:
Troughton RW, Frampton CM, Brunner-La Rocca HP, et al.
Citation:
Eur Heart J 2014;Mar 6:[Epub ahead of print].
Summary By:
Ragavendra R. Baliga, MBBS, FACC

Study Questions:

What is the effect of natriuretic peptide (NP)-guided treatment of heart failure (HF) on all-cause mortality?

Methods:

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.

Results:

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.

Conclusions:

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.

Perspective:

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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