A Meta-Analysis of Neurohormone-Driven Treatment for Heart Failure

Findings favor a B-type natriuretic peptide–guided approach, particularly in younger patients, but will not quell the controversy.

Advocates of the use of patients' natriuretic peptide levels to guide heart failure therapy have been disappointed by the results of a string of studies that failed to demonstrate meaningful benefits of this approach (JW Cardiol Apr 25 2007, Jan 27 2009, and Feb 10 2010). However, possible benefits were found with regard to some secondary outcomes, and findings from two studies suggested benefits in younger patient subgroups. Now, investigators have performed a meta-analysis of eight randomized controlled studies that compared usual clinical care with therapy guided by B-type natriuretic peptide (BNP) or N-terminal pro-BNP level in a total of 1726 outpatients with heart failure.

The studies varied substantially in size, treatment targets, du…

Reviewing Author

Frederick A. Masoudi, MD, MSPH

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)