TitleB-type Natriuretic Peptide-guided Chronic Heart Failure Therapy: A Meta-analysis of 11 Randomised Controlled Trials
AuthorsLi, Peng
Luo, Yong
Chen, Yi-Ming
AffiliationPeking Univ, Shougang Hosp, Dept ICU, Beijing 100871, Peoples R China.
Capital Med Univ, Beijing Chao Yang Hosp, Dept Pediat, Beijing, Peoples R China.
9 Jinyuan Zhuang Rd, Beijing 0086100144, Peoples R China.
KeywordsBNP
Chronic heart failure
Prognosis
Rehospitalisation
VENTRICULAR SYSTOLIC DYSFUNCTION
INTERVENTION TRIAL
DOUBLE-BLIND
NT-PROBNP
VAL-HEFT
MERIT-HF
CARE
MORTALITY
BNP
MANAGEMENT
Issue Date2013
CitationHEART LUNG AND CIRCULATION.2013,22,(10),852-860.
AbstractBackground: The use of plasma levels of B-type natriuretic peptides (BNPs) to guide treatment of patients with chronic heart failure (HF) has been investigated in a number of randomised controlled trials (RCTs). However, the benefits have been variable. We therefore performed a meta-analysis to examine the overall effect of BNP-guided drug therapy on all-cause mortality and HF rehospitalisation in patients with chronic HE Methods: We identified RCTs by systematic search of MEDLINE, EMBASE and the Cochrane Controlled Clinical Trials Register Database. Eligible RCTs were those that enrolled more than 40 patients and involved comparison of BNP-guided versus guideline-guided drug therapy of the patients with chronic HF in the outpatient setting. Results: Eleven RCTs with a total of 2414 patients and with a mean duration of 12 months (range, 3-36 months) were included in the meta-analysis. Overall, there was a significantly decreased risk of all-cause mortality (relative risk [RR], 0.83; 95% confidence interval [CI], 0.69-0.99; P = 0.035; I-2 = 0%) and HF rehospitalisation (RR, 0.75; 95% CI, 0.62-0.91; P = 0.004; I-2 = 62.2%) in the BNP-guided therapy group. Age, baseline BNP are the major dominants of HF rehospitalisation when analysed using meta-regression. In the subgroup analysis, HF rehospitalisation was significantly decreased in the patients younger than 70 years (RR, 0.45; 95% CI, 0.33-0.61;P = 0.000; I-2 = 0.0%), or with baseline higher BNP (>= 2114 pg/mL) (RR, 0.53; 95% CI, 0.39-0.72; P = 0.000; I-2 = 21.8%). Conclusions: Compared with usual clinical care, B-type natriuretic peptide-guided therapy reduces all-cause mortality and HF rehospitalisation, especially in patients younger than 70 years or with higher baseline BNP. (C) 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
URIhttp://hdl.handle.net/20.500.11897/190541
ISSN1443-9506
DOI10.1016/j.hlc.2013.03.077
IndexedSCI(E)
PubMed
Appears in Collections:首钢医院

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