PMID- 30064502 OWN - NLM STAT- MEDLINE DCOM- 20190226 LR - 20210109 IS - 2046-4053 (Electronic) IS - 2046-4053 (Linking) VI - 7 IP - 1 DP - 2018 Jul 31 TI - B-type natriuretic peptide-guided therapy for heart failure (HF): a systematic review and meta-analysis of individual participant data (IPD) and aggregate data. PG - 112 LID - 10.1186/s13643-018-0776-8 [doi] LID - 112 AB - BACKGROUND: We estimated the effectiveness of serial B-type natriuretic peptide (BNP) blood testing to guide up-titration of medication compared with symptom-guided up-titration of medication in patients with heart failure (HF). METHODS: Systematic review and meta-analysis of randomised controlled trials (RCTs). We searched: MEDLINE (Ovid) 1950 to 9/06/2016; Embase (Ovid), 1980 to 2016 week 23; the Cochrane Library; ISI Web of Science (Citations Index and Conference Proceedings). The primary outcome was all-cause mortality; secondary outcomes were death related to HF, cardiovascular death, all-cause hospital admission, hospital admission for HF, adverse events, and quality of life. IPD were sought from all RCTs identified. Random-effects meta-analyses (two-stage) were used to estimate hazard ratios (HR) and confidence intervals (CIs) across RCTs, including HR estimates from published reports of studies that did not provide IPD. We estimated treatment-by-covariate interactions for age, gender, New York Heart Association (NYHA) class, HF type; diabetes status and baseline BNP subgroups. Dichotomous outcomes were analysed using random-effects odds ratio (OR) with 95% CI. RESULTS: We identified 14 eligible RCTs, five providing IPD. BNP-guided therapy reduced the hazard of hospital admission for HF by 19% (13 RCTs, HR 0.81, 95% CI 0.68 to 0.98) but not all-cause mortality (13 RCTs; HR 0.87, 95% CI 0.75 to 1.01) or cardiovascular mortality (5 RCTs; OR 0.88, 95% CI 0.67 to 1.16). For all-cause mortality, there was a significant interaction between treatment strategy and age (p = 0.034, 11 RCTs; HR 0.70, 95% CI 0.53-0.92, patients < 75 years old and HR 1.07, 95% CI 0.84-1.37, patients >/= 75 years old); ejection fraction (p = 0.026, 11 RCTs; HR 0.84, 95% CI 0.71-0.99, patients with heart failure with reduced ejection fraction (HFrEF); and HR 1.33, 95% CI 0.83-2.11, patients with heart failure with preserved ejection fraction (HFpEF)). Adverse events were significantly more frequent with BNP-guided therapy vs. symptom-guided therapy (5 RCTs; OR 1.29, 95% CI 1.04 to 1.60). CONCLUSION: BNP-guided therapy did not reduce mortality but reduced HF hospitalisation. The overall quality of the evidence varied from low to very low. The relevance of these findings to unselected patients, particularly those managed by community generalists, are unclear. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42013005335. FAU - Pufulete, Maria AU - Pufulete M AUID- ORCID: 0000-0002-1775-1949 AD - Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary, Queen's Building, Bristol, BS2 8HW, UK. maria.pufulete@bristol.ac.uk. FAU - Maishman, Rachel AU - Maishman R AD - Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary, Queen's Building, Bristol, BS2 8HW, UK. FAU - Dabner, Lucy AU - Dabner L AD - Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary, Queen's Building, Bristol, BS2 8HW, UK. FAU - Higgins, Julian P T AU - Higgins JPT AD - School of Social and Community Medicine, University of Bristol, Bristol, UK. FAU - Rogers, Chris A AU - Rogers CA AD - Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary, Queen's Building, Bristol, BS2 8HW, UK. FAU - Dayer, Mark AU - Dayer M AD - Department of Cardiology, Taunton and Somerset NHS Foundation Trust, Taunton, UK. FAU - MacLeod, John AU - MacLeod J AD - School of Social and Community Medicine, University of Bristol, Bristol, UK. FAU - Purdy, Sarah AU - Purdy S AD - School of Social and Community Medicine, University of Bristol, Bristol, UK. FAU - Hollingworth, William AU - Hollingworth W AD - School of Social and Community Medicine, University of Bristol, Bristol, UK. FAU - Schou, Morten AU - Schou M AD - Herlev and Gentofte University Hospital, Herlev, DK-2730, Copenhagen, Denmark. FAU - Anguita-Sanchez, Manuel AU - Anguita-Sanchez M AD - Agencia de Investigacion de la Sociedad Espanola de Cardiologia, Madrid, Spain. FAU - Karlstrom, Patric AU - Karlstrom P AD - Division of Cardiology, Department of Medicine, County Hospital Ryhov, Jonkoping, Sweden. FAU - Shochat, Michael Kleiner AU - Shochat MK AD - Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel. FAU - McDonagh, Theresa AU - McDonagh T AD - Cardiovascular Division, King's College Hospital, King's College London, Denmark Hill, London, SE5 9RS, UK. FAU - Nightingale, Angus K AU - Nightingale AK AD - Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, BS2 8HW, UK. FAU - Reeves, Barnaby C AU - Reeves BC AD - Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary, Queen's Building, Bristol, BS2 8HW, UK. LA - eng GR - 11/102/03/DH_/Department of Health/United Kingdom GR - 11-102-03/Health Technology Assessment Programme/International PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20180731 PL - England TA - Syst Rev JT - Systematic reviews JID - 101580575 RN - 114471-18-0 (Natriuretic Peptide, Brain) SB - IM MH - Cause of Death MH - Heart Failure/*drug therapy/mortality MH - *Hospitalization MH - Humans MH - Mortality MH - Natriuretic Peptide, Brain/blood/*drug effects MH - *Quality of Life MH - Randomized Controlled Trials as Topic PMC - PMC6069819 OTO - NOTNLM OT - B-type natriuretic peptide OT - Heart failure OT - IPD meta-analysis OT - Systematic review COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: All original trials reported gaining the approval of an appropriate human ethics committee. The current analysis involves a secondary analysis of anonymised data; therefore, it does not require separate ethics committee approval. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/08/02 06:00 MHDA- 2019/02/27 06:00 PMCR- 2018/07/31 CRDT- 2018/08/02 06:00 PHST- 2018/03/09 00:00 [received] PHST- 2018/07/16 00:00 [accepted] PHST- 2018/08/02 06:00 [entrez] PHST- 2018/08/02 06:00 [pubmed] PHST- 2019/02/27 06:00 [medline] PHST- 2018/07/31 00:00 [pmc-release] AID - 10.1186/s13643-018-0776-8 [pii] AID - 776 [pii] AID - 10.1186/s13643-018-0776-8 [doi] PST - epublish SO - Syst Rev. 2018 Jul 31;7(1):112. doi: 10.1186/s13643-018-0776-8.