Despite significant furtherance in the medical management of heart failure (HF), readmission
and mortality following HF hospitalization are significantly high. Traditionally,
optimization of medical therapy, which includes angiotensin-converting enzyme (ACE)
inhibitors, beta-blockers, diuretics, and aldosterone antagonist is mainly guided
by symptomatology and patient tolerance. Left ventricular wall stretch provokes secretion
of plasma brain natriuretic peptide (BNP) and N-terminal pro BNP (NT-pro BNP), which
are proposed as markers to guide and optimize medical therapy. Several studies have
reported natriuretic peptide guided therapy to be superior in reducing HF readmission
events and mortality as contrasted with clinical symptoms guided therapy alone [
[1]
,
[2]
]. However, the results are inconsistent. Additionally, the 2017 ACC/AHA/HFSA Focused
Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure documents
the following statement – “Because of the absence of clear and consistent evidence
for improvement in mortality and cardiovascular outcomes, there are insufficient data
to inform specific guideline recommendations related to natriuretic peptide–guided
therapy or serial measurements of BNP or NT-proBNP levels for the purpose of reducing
hospitalization or deaths in the present document” . Former meta-analyses pooled clinically
heterogeneous studies of patients with acute/chronic HF and heart failure with reduced
ejection fraction (HFrEF)/ heart failure with preserved ejection fraction (HFpEF).
Hence, we performed a meta-analysis including all the randomized control trials (RCTs)
comparing BNP lowering therapy to standard clinical symptoms guided therapy among
patients with chronic HFrEF. The usefulness of BNP lowering strategy for guiding treatment
in HFrEF will thus be inferred.To read this article in full you will need to make a payment
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References
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Article info
Publication history
Published online: May 26, 2020
Accepted:
May 16,
2020
Received in revised form:
May 11,
2020
Received:
March 7,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
