Essential components in natriuretic peptide-guided management of heart failure: An intervention synthesis

Aims: To identify the key components of natriuretic peptide (NP)-guided treatment interventions which reduced hospitalisation in patients with heart failure (HF). Methods and results: We extracted detailed information on the components of interventions from studies of NP-guided treatment of HF identified in a previous systematic review. We used meta-regression techniques to assess univariate associations between components and the strength of the reduction in HF hospitalisations and all-cause mortality. A Bayesian meta-analysis approach was used to re-estimate study level effects in order to identify the study with the most effective NP-guided monitoring intervention. Finally, we examined the intervention options common to the studies in which the 95% credible interval excluded no effect. We identified 8 components of NP-guided treatment from ten studies. Univariate comparisons produced mainly equivocal results but single trial choice and common components analysis led to similar conclusions. Utilising a pre-defined treatment protocol, setting a stringent NP-target (NT-proBNP of 1000 pg/ml or BNP 100 pg/ml), including a relative target and monitoring every three months in the titration phase were potentially key components to reducing HF hospitalisations using NP-guided therapy. Conclusion: This analysis provides a description of the key components of NP-guided treatment which could help policy makers develop specific recommendations for HF management. Our research suggests that NP-guided interventions could be simplified, but more research in relevant health settings, such as primary care, is required