Essential components in natriuretic peptide-guided management of heart failure: An intervention synthesis
Oke J., Mclellan JH., Bankhead C., Taylor C., Perera R.
Aims: To identify the key components of natriuretic peptide (NP)-guided treatment interventions which reduced hospitalisation in patients with heart failure (HF). Methods and results: We extracted detailed information on the components of interventions from studies of NP-guided treatment of HF identified in a previous systematic review. We used meta-regression techniques to assess univariate associations between components and the strength of the reduction in HF hospitalisations and all-cause mortality. A Bayesian meta-analysis approach was used to re-estimate study level effects in order to identify the study with the most effective NP-guided monitoring intervention. Finally, we examined the intervention options common to the studies in which the 95% credible interval excluded no effect. We identified 8 components of NP-guided treatment from ten studies. Univariate comparisons produced mainly equivocal results but single trial choice and common components analysis led to similar conclusions. Utilising a pre-defined treatment protocol, setting a stringent NP-target (NT-proBNP of 1000 pg/ml or BNP 100 pg/ml), including a relative target and monitoring every three months in the titration phase were potentially key components to reducing HF hospitalisations using NP-guided therapy. Conclusion: This analysis provides a description of the key components of NP-guided treatment which could help policy makers develop specific recommendations for HF management. Our research suggests that NP-guided interventions could be simplified, but more research in relevant health settings, such as primary care, is required. Keywords (A maximum of six keywords may be submitted.) Heart Failure, natriuretic peptide, hospitalisation, monitoring