B-type natriuretic peptide-guided therapy: a systematic review

Area of Science:

• Cardiology
• Biomarkers
• Evidence-Based Medicine

Background:

• Brain Natriuretic Peptide (BNP) and N-terminal pro-BNP (NT-proBNP) measurements are not widely used for heart failure (HF) management.
• Despite existing randomized controlled trials (RCTs), their clinical utility remains debated.

Purpose of the Study:

• To systematically review RCTs to determine if BNP/NT-proBNP-assisted therapy benefits patients with chronic HF compared to usual care.
• To assess the quality of evidence supporting biomarker-guided HF management.

Main Methods:

• A systematic review of RCTs published from 1980 to 2012 was conducted.
• Searches included Medline, Embase, AMED, Cochrane, and CINAHL databases.
• Nine RCTs involving 2,104 patients were identified, focusing on medical therapy guided by BNP/NT-proBNP versus usual care.

Main Results:

• Significant heterogeneity in study design, patient selection, therapy goals, and outcome reporting was observed across the nine RCTs.
• Meta-analysis was not feasible due to this heterogeneity.
• The evidence for mortality outcomes was of low quality, characterized by inconsistency and imprecision.

Conclusions:

• Current evidence is of low quality and insufficient to support the use of BNP/NT-proBNP measurements to guide heart failure therapy.
• Further well-designed clinical trials are necessary to clarify the role of these biomarkers in HF management.