TY - JOUR
T1 - Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization
T2 - an individual patient meta-analysis
AU - Troughton, Richard W
AU - Frampton, Christopher M
AU - Brunner-La Rocca, Hans-Peter
AU - Pfisterer, Matthias
AU - Eurlings, Luc W M
AU - Erntell, Hans
AU - Persson, Hans
AU - O'Connor, Christopher M
AU - Moertl, Deddo
AU - Karlström, Patric
AU - Dahlström, Ulf
AU - Gaggin, Hanna K
AU - Januzzi, James L
AU - Berger, Rudolf
AU - Richards, A Mark
AU - Pinto, Yigal M
AU - Nicholls, M Gary
N1 - Funding Information:
Conflicts of interest: R.T.—grant support and honoraria from Roche Diagnostics and St Jude Medical. L. E.—consultancy fees from Roche Diagnostics. J.J.–grant support from Roche Diagnostics, BG Medicine, Critical Diagnostics, Brahms; Consultancy fees from Sphingotec, Critical Diagnostics. M.R.—Honoraria, travel grants and research grants from Roche Diagnostics and Alere. H.-P.B.L.—grant support from Roche Diagnostics. C.O’C.—institutional grant support from Roche Diagnostics. U.D.—consultancies and honoraria from Vitor Pharma. The remaining authors report no conflicts of interest.
PY - 2014/6/14
Y1 - 2014/6/14
N2 - AIMS: Natriuretic peptide-guided (NP-guided) treatment of heart failure has been tested against standard clinically guided care in multiple studies, but findings have been limited by study size. We sought to perform an individual patient data meta-analysis to evaluate the effect of NP-guided treatment of heart failure on all-cause mortality.METHODS AND RESULTS: Eligible randomized clinical trials were identified from searches of Medline and EMBASE databases and the Cochrane Clinical Trials Register. The primary pre-specified outcome, all-cause mortality was tested 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. Secondary endpoints included heart failure or cardiovascular hospitalization. Of 11 eligible studies, 9 provided individual patient data and 2 aggregate data. For the primary endpoint individual data from 2000 patients were included, 994 randomized to clinically guided care and 1006 to NP-guided care. All-cause mortality was significantly reduced by NP-guided treatment [hazard ratio = 0.62 (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) patients [0.62 (0.45-0.85); P = 0.004] but not older (≥75 years) patients [0.98 (0.75-1.27); P = 0.96]. Hospitalization due to heart failure [0.80 (0.67-0.94); P = 0.009] or cardiovascular disease [0.82 (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.CONCLUSION: Natriuretic peptide-guided treatment of heart failure reduces all-cause mortality in patients aged <75 years and overall reduces heart failure and cardiovascular hospitalization.
AB - AIMS: Natriuretic peptide-guided (NP-guided) treatment of heart failure has been tested against standard clinically guided care in multiple studies, but findings have been limited by study size. We sought to perform an individual patient data meta-analysis to evaluate the effect of NP-guided treatment of heart failure on all-cause mortality.METHODS AND RESULTS: Eligible randomized clinical trials were identified from searches of Medline and EMBASE databases and the Cochrane Clinical Trials Register. The primary pre-specified outcome, all-cause mortality was tested 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. Secondary endpoints included heart failure or cardiovascular hospitalization. Of 11 eligible studies, 9 provided individual patient data and 2 aggregate data. For the primary endpoint individual data from 2000 patients were included, 994 randomized to clinically guided care and 1006 to NP-guided care. All-cause mortality was significantly reduced by NP-guided treatment [hazard ratio = 0.62 (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) patients [0.62 (0.45-0.85); P = 0.004] but not older (≥75 years) patients [0.98 (0.75-1.27); P = 0.96]. Hospitalization due to heart failure [0.80 (0.67-0.94); P = 0.009] or cardiovascular disease [0.82 (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.CONCLUSION: Natriuretic peptide-guided treatment of heart failure reduces all-cause mortality in patients aged <75 years and overall reduces heart failure and cardiovascular hospitalization.
KW - Aged
KW - Angiotensin Receptor Antagonists/therapeutic use
KW - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
KW - Biomarkers/metabolism
KW - Chronic Disease
KW - Drug Substitution/statistics & numerical data
KW - Female
KW - Heart Failure/blood
KW - Hospitalization/statistics & numerical data
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Natriuretic Peptide, Brain/metabolism
KW - Randomized Controlled Trials as Topic
KW - Sodium Potassium Chloride Symporter Inhibitors/therapeutic use
KW - Treatment Outcome
KW - Ventricular Dysfunction, Left/blood
KW - Heart failure
KW - B-type Natriuretic peptide
KW - Natriuretic peptides
UR - http://www.scopus.com/inward/record.url?scp=84902577748&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehu090
DO - 10.1093/eurheartj/ehu090
M3 - Journal article
C2 - 24603309
SN - 0195-668X
VL - 35
SP - 1559
EP - 1567
JO - European Heart Journal
JF - European Heart Journal
IS - 23
ER -