Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis

被引：224

作者：

Troughton, Richard W. ^{[1
]}

Frampton, Christopher M. ^{[1
]}

Brunner-La Rocca, Hans-Peter ^{[4
]}

Pfisterer, Matthias ^{[3
]}

Eurlings, Luc W. M. ^{[4
]}

Erntell, Hans ^{[5
]}

Persson, Hans ^{[5
]}

O'Connor, Christopher M. ^{[6
]}

Moertl, Deddo ^{[8
]}

Karlstrom, Patric ^{[9
]}

Dahlstrom, Ulf ^{[10
]}

Gaggin, Hanna K. ^{[11
]}

Januzzi, James L. ^{[11
]}

Berger, Rudolf ^{[7
]}

Richards, A. Mark ^{[2
]}

Pinto, Yigal M. ^{[12
]}

Nicholls, M. Gary ^{[1
]}

机构：

[1] Univ Otago, Christchurch Hosp, Dept Med, Christchurch 8140, New Zealand

[2] Natl Univ Heart Ctr Singapore, Singapore, Singapore

[3] Univ Basel Hosp, Dept Cardiol, CH-4031 Basel, Switzerland

[4] Maastricht Univ Med Ctr, Dept Cardiol, Maastricht, Netherlands

[5] Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden

[6] Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA

[7] Med Univ Vienna, Dept Cardiol, Vienna, Austria

[8] LKH, Dept Cardiol, St Polten, Austria

[9] Cty Hosp Ryhov, Dept Med, Div Cardiol, Jonkoping, Sweden

[10] Linkoping Univ, Cty Council Ostergotland, Dept Cardiol, Dept Med & Hlth Sci, Linkoping, Sweden

[11] Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA

[12] Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands

来源：

EUROPEAN HEART JOURNAL | 2014年 / 35卷 / 23期

关键词：

Natriuretic peptides; B-type Natriuretic peptide; Heart failure;

D O I：

10.1093/eurheartj/ehu090

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims Natriuretic peptide-guided (NP-guided) treatment of heart failure has been tested against standard clinically guided care in multiple studies, but findings have been limited by study size. We sought to perform an individual patient data meta-analysis to evaluate the effect of NP-guided treatment of heart failure on all-cause mortality. Methods and results ligible randomized clinical trials were identified from searches of Medline and EMBASE databases and the Cochrane Clinical Trials Register. The primary pre-specified outcome, all-cause mortality was tested using a Cox proportional hazards regression model that included study of origin, age (< 75 or >= 75 years), and left ventricular ejection fraction (LVEF, <= 45 or > 45%) as covariates. Secondary endpoints included heart failure or cardiovascular hospitalization. Of 11 eligible studies, 9 provided individual patient data and 2 aggregate data. For the primary endpoint individual data from 2000 patients were included, 994 randomized to clinically guided care and 1006 to NP-guided care. All-cause mortality was significantly reduced by NP-guided treatment [hazard ratio = 0.62 (0.45-0.86); P = 0.004] with no heterogeneity between studies or interaction with LVEF. The survival benefit from NP-guided therapy was seen in younger (< 75 years) patients [0.62 (0.45-0.85); P = 0.004] but not older (>= 75 years) patients [0.98 (0.75-1.27); P = 0.96]. Hospitalization due to heart failure [0.80 (0.67-0.94); P = 0.009] or cardiovascular disease [0.82 (0.67-0.99); P = 0.048] was significantly lower in NP-guided patients with no heterogeneity between studies and no interaction with age or LVEF. Conclusion Natriuretic peptide-guided treatment of heart failure reduces all-cause mortality in patients aged < 75 years and overall reduces heart failure and cardiovascular hospitalization.

引用

页码：1559 / 1567

页数：9

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