Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.

<h4>Background</h4>The role of cardiac natriuretic peptides in the management of patients with chronic heart failure (HF) remains uncertain. The purpose of this study was to evaluate whether natriuretic peptide-guided therapy, compared to clinically-guided therapy, improves mortality and...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Gianluigi Savarese, Bruno Trimarco, Santo Dellegrottaglie, Maria Prastaro, Francesco Gambardella, Giuseppe Rengo, Dario Leosco, Pasquale Perrone-Filardi
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3ace206a9d484bb3bdba46111f00fa7f
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:3ace206a9d484bb3bdba46111f00fa7f
record_format	dspace
spelling	oai:doaj.org-article:3ace206a9d484bb3bdba46111f00fa7f2021-11-18T07:54:49ZNatriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.1932-620310.1371/journal.pone.0058287https://doaj.org/article/3ace206a9d484bb3bdba46111f00fa7f2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23472172/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>The role of cardiac natriuretic peptides in the management of patients with chronic heart failure (HF) remains uncertain. The purpose of this study was to evaluate whether natriuretic peptide-guided therapy, compared to clinically-guided therapy, improves mortality and hospitalization rate in patients with chronic HF.<h4>Methodology/principal findings</h4>MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases were searched for articles reporting natriuretic peptide-guided therapy in HF until August 2012. All randomized trials reporting clinical end-points (all-cause mortality and/or HF-related hospitalization and/or all-cause hospitalization) were included. Meta-analysis was performed to assess the influence of treatment on outcomes. Sensitivity analysis was performed to test the influence of potential effect modifiers and of each trial included in meta-analysis on results. Twelve trials enrolling 2,686 participants were included. Natriuretic peptide-guided therapy (either B-type natriuretic peptide [BNP]- or N-terminal pro-B-type natriuretic peptide [NT-proBNP]-guided therapy) significantly reduced all-cause mortality (Odds Ratio [OR]:0.738; 95% Confidence Interval [CI]:0.596 to 0.913; p = 0.005) and HF-related hospitalization (OR:0.554; CI:0.399 to 0.769; p = 0.000), but not all-cause hospitalization (OR:0.803; CI:0.629 to 1.024; p = 0.077). When separately assessed, NT-proBNP-guided therapy significantly reduced all-cause mortality (OR:0.717; CI:0.563 to 0.914; p = 0.007) and HF-related hospitalization (OR:0.531; CI:0.347 to 0.811; p = 0.003), but not all-cause hospitalization (OR:0.779; CI:0.414 to 1.465; p = 0.438), whereas BNP-guided therapy did not significantly reduce all-cause mortality (OR:0.814; CI:0.518 to 1.279; p = 0.371), HF-related hospitalization (OR:0.599; CI:0.303 to 1.187; p = 0.142) or all-cause hospitalization (OR:0.726; CI:0.509 to 1.035; p = 0.077). [corrected].<h4>Conclusions/significance</h4>Use of cardiac peptides to guide pharmacologic therapy significantly reduces mortality and HF related hospitalization in patients with chronic HF. In particular, NT-proBNP-guided therapy reduced all-cause mortality and HF-related hospitalization but not all-cause hospitalization, whereas BNP-guided therapy did not significantly reduce both mortality and morbidity.Gianluigi SavareseBruno TrimarcoSanto DellegrottaglieMaria PrastaroFrancesco GambardellaGiuseppe RengoDario LeoscoPasquale Perrone-FilardiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 3, p e58287 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Gianluigi Savarese Bruno Trimarco Santo Dellegrottaglie Maria Prastaro Francesco Gambardella Giuseppe Rengo Dario Leosco Pasquale Perrone-Filardi Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.
description	<h4>Background</h4>The role of cardiac natriuretic peptides in the management of patients with chronic heart failure (HF) remains uncertain. The purpose of this study was to evaluate whether natriuretic peptide-guided therapy, compared to clinically-guided therapy, improves mortality and hospitalization rate in patients with chronic HF.<h4>Methodology/principal findings</h4>MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases were searched for articles reporting natriuretic peptide-guided therapy in HF until August 2012. All randomized trials reporting clinical end-points (all-cause mortality and/or HF-related hospitalization and/or all-cause hospitalization) were included. Meta-analysis was performed to assess the influence of treatment on outcomes. Sensitivity analysis was performed to test the influence of potential effect modifiers and of each trial included in meta-analysis on results. Twelve trials enrolling 2,686 participants were included. Natriuretic peptide-guided therapy (either B-type natriuretic peptide [BNP]- or N-terminal pro-B-type natriuretic peptide [NT-proBNP]-guided therapy) significantly reduced all-cause mortality (Odds Ratio [OR]:0.738; 95% Confidence Interval [CI]:0.596 to 0.913; p = 0.005) and HF-related hospitalization (OR:0.554; CI:0.399 to 0.769; p = 0.000), but not all-cause hospitalization (OR:0.803; CI:0.629 to 1.024; p = 0.077). When separately assessed, NT-proBNP-guided therapy significantly reduced all-cause mortality (OR:0.717; CI:0.563 to 0.914; p = 0.007) and HF-related hospitalization (OR:0.531; CI:0.347 to 0.811; p = 0.003), but not all-cause hospitalization (OR:0.779; CI:0.414 to 1.465; p = 0.438), whereas BNP-guided therapy did not significantly reduce all-cause mortality (OR:0.814; CI:0.518 to 1.279; p = 0.371), HF-related hospitalization (OR:0.599; CI:0.303 to 1.187; p = 0.142) or all-cause hospitalization (OR:0.726; CI:0.509 to 1.035; p = 0.077). [corrected].<h4>Conclusions/significance</h4>Use of cardiac peptides to guide pharmacologic therapy significantly reduces mortality and HF related hospitalization in patients with chronic HF. In particular, NT-proBNP-guided therapy reduced all-cause mortality and HF-related hospitalization but not all-cause hospitalization, whereas BNP-guided therapy did not significantly reduce both mortality and morbidity.
format	article
author	Gianluigi Savarese Bruno Trimarco Santo Dellegrottaglie Maria Prastaro Francesco Gambardella Giuseppe Rengo Dario Leosco Pasquale Perrone-Filardi
author_facet	Gianluigi Savarese Bruno Trimarco Santo Dellegrottaglie Maria Prastaro Francesco Gambardella Giuseppe Rengo Dario Leosco Pasquale Perrone-Filardi
author_sort	Gianluigi Savarese
title	Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.
title_short	Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.
title_full	Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.
title_fullStr	Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.
title_full_unstemmed	Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.
title_sort	natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/3ace206a9d484bb3bdba46111f00fa7f
work_keys_str_mv	AT gianluigisavarese natriureticpeptideguidedtherapyinchronicheartfailureametaanalysisof2686patientsin12randomizedtrials AT brunotrimarco natriureticpeptideguidedtherapyinchronicheartfailureametaanalysisof2686patientsin12randomizedtrials AT santodellegrottaglie natriureticpeptideguidedtherapyinchronicheartfailureametaanalysisof2686patientsin12randomizedtrials AT mariaprastaro natriureticpeptideguidedtherapyinchronicheartfailureametaanalysisof2686patientsin12randomizedtrials AT francescogambardella natriureticpeptideguidedtherapyinchronicheartfailureametaanalysisof2686patientsin12randomizedtrials AT giusepperengo natriureticpeptideguidedtherapyinchronicheartfailureametaanalysisof2686patientsin12randomizedtrials AT darioleosco natriureticpeptideguidedtherapyinchronicheartfailureametaanalysisof2686patientsin12randomizedtrials AT pasqualeperronefilardi natriureticpeptideguidedtherapyinchronicheartfailureametaanalysisof2686patientsin12randomizedtrials
_version_	1718422779286519808

Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.

Ejemplares similares