Evaluation of natriuretic peptide recommendations in heart failure clinical practice guidelines

The B-type naturietic peptides (NPs) are associated with heart failure (HF). This investigation was designed to evaluate heart failure clinical practice guideline (CPG) recommendations for the use of NPs.

A search for English language CPGs for HF published since 2011 was conducted. A search for systematic reviews (SR) and meta-analysis for NPs in HF was conducted for the years 2004-2012. Each HF CPG was evaluated by two independent reviewers. Key recommendations for NPs and the supporting references were abstracted. The key findings from each SR were abstracted.

Seven English language HF CPGs were found, all of which made recommendations for the use of NPs in diagnosis. Four made recommendations for prognosis and three for management. The European CPG scored highly for rigor of development with the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) while the others did not. North American CPGs made stronger recommendations citing higher grades of evidence for the use of NPs in HF than the European or Australian CPGs. The CPGs mostly cited primary studies 47/66 to support the recommendations. From twelve available SRs, five were cited by CPGs. One CPG conducted a SR.

The SR evidence to support NP use in CPGs has not been well cited in the CPGs and the recommendations are only partially supported by the SR evidence. Future CPGs should consider improving the methodology used to evaluate laboratory tests.