Effect of Carperitide on Clinical Outcomes in Patients With Heart Failure: A Systematic Review and Meta-Analysis

Heart failure remains a leading global health burden affecting over 64 million individuals worldwide, with limited effective acute management strategies. Carperitide, a recombinant form of human atrial natriuretic peptide, has been primarily used in Japan for acute heart failure treatment, but its clinical efficacy remains controversial. This systematic review and meta-analysis aimed to evaluate the clinical outcomes of carperitide in heart failure patients. A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to July 2025, using terms related to carperitide and heart failure. Studies involving adult heart failure patients receiving carperitide that reported cardiovascular mortality, all-cause mortality, or heart failure-related hospitalization were included. Six studies met inclusion criteria, comprising three observational studies, two randomized controlled trials, and one secondary analysis, published between 2008 and 2025. Meta-analysis was performed using RevMan 4.5.1 (The Cochrane Collaboration) with random-effects models. The pooled analysis of four studies examining all-cause mortality demonstrated no significant difference between carperitide and control groups (risk ratio (RR): 1.02, 95% confidence interval (CI): 0.63-1.66), with substantial heterogeneity (I² = 66%). Similarly, hospitalization due to heart failure showed no significant difference (RR: 0.98, 95% CI: 0.85-1.14) with no heterogeneity (I² = 0%). Composite outcomes of hospitalization and death also revealed no significant benefit (RR: 0.98, 95% CI: 0.85-1.14). This meta-analysis provides evidence that carperitide does not significantly improve clinical outcomes in heart failure patients, challenging its widespread use and supporting the need for evidence-based therapeutic alternatives in heart failure management.