The role of natriuretic peptide-guided therapy in heart failure management

Natriuretic peptide has been validated as a useful biomarker in the diagnosis of heart failure. Its role in guiding medical management of heart failure is not well established. Our objective is to determine if natriuretic peptide-guided therapy is associated with improved outcomes for heart failure patients. We conducted a PubMed search to identify prospective randomized controlled trials evaluating natriuretic peptide-guided therapy. 12 trials (2,688 patients) comparing natriuretic peptide-guided therapy to standard therapy for heart failure patients were identified, with follow-up times ranging from 3 months to 3 years. Our data indicates that natriuretic peptide levels and all-cause mortality rates do not appear to benefit from natriuretic peptide-guided therapy compared to standard therapy. However, a decreased rate of cardiovascular events does appear to be associated with natriuretic peptide-guided therapy.