Table 4 Summary of findings table
Serial B-type natriuretic peptide (BNP) blood testing to guide up-titration of medication compared to symptom-guided up-titration of medication in patients with heart failure (HF) | ||||||
|---|---|---|---|---|---|---|
Patient or population: patients with heart failure (HF) Setting: secondary care Intervention: serial B-type natriuretic peptide (BNP) blood testing to guide up-titration of medication Comparison: symptom-guided up-titration of medication | ||||||
Outcome No. of participants (studies) | Relative effect (95% CI) | Anticipated absolute effects (95% CI) | Certainty | What happens | ||
Without serial B-type natriuretic peptide (BNP) blood testing to guide up-titration of medication | With serial B-type natriuretic peptide (BNP) blood testing to guide up-titration of medication | Difference | ||||
All-cause mortality follow up: range 3 to 30 months No. of participants: 3691 (13 RCTs) | HR 0.87 (0.71 to 1.01) | 19.9% | 17.5% (14.6 to 20.1) | 2.3% fewer (5.3 fewer to 0.2 more) | ⨁⨁◯◯ Lowa,b | BNP-guided therapy may result in little to no difference in all-cause mortality. |
Death related to HF follow up: range 12 to 15 months No. of participants: 488 (2 RCTs) | Two studies reported death related to HF. There were no significant differences between the BNP-guided therapy and the symptom-guided therapy groups in either study (3/110 vs. 9/110, respectively, and 21/140 vs. 16/128, respectively). | ⨁◯◯◯Very low a,b,c | It is uncertain whether BNP-guided therapy prevents death related to HF because the quality of the evidence is very low. | |||
Cardiovascular death follow up: range 9 to 23 months No. of participants: 1909 (5 RCTs) | OR 0.88 (0.67 to 1.16) | 13.7% | 12.3% (9.6 to 15.6) | 1.4% fewer (4.1 fewer to 1.9 more) | ⨁⨁◯◯ Low a,b | BNP-guided therapy may lead to little or no difference in cardiovascular death. |
All-cause hospitalisation follow up: range 3 to 30 months No. of participants: 984 (7 RCTs) | HR 0.97 (0.85 to 1.10) | 57.2% | 56.1% (51.4 to 60.7) | 1.1% fewer (5.8 fewer to 3.5 more) | ⨁⨁◯◯ Lowa,b | BNP-guided therapy may result in little or no difference in all-cause hospitalisation. |
HF hospitalisation follow up: range 9 to 30 months No. of participants: 2655 (8 RCTs) | HR 0.81 (0.68 to 0.98) | 34.1% | 28.6% (24.7 to 33.5) | 5.4% fewer (9.4 fewer to 0.6 fewer) | ⨁◯◯◯ Very lowa,b,d | It is uncertain whether BNP-guided therapy reduces hospital admissions for HF because the quality of evidence is very low. |
Adverse events follow up: range 9 to 18 months No. of participants: 2055 (5 RCTs) | OR 1.29 (1.04 to 1.60) | 24.4% | 29.4% (25.1 to 34.1) | 5.0% more (0.7 more to 9.7 more) | ⨁⨁◯◯ Lowa,b | BNP-guided therapy may lead to an increase in adverse events. |
Quality of life follow up: range 10 to 30 months No. of participants: 1884 (6 RCTs) | Six studies reported data on QoL (five used the Minnesota Living with Heart Failure Questionnaire and one used SF-36) in their published report. Data could not be combined in a meta-analysis because changes in QoL were reported differently in each study. Only one study reported a significant improvement in QoL in the BNP-guided therapy group vs. symptom guided therapy group; five reported no difference between groups. Three additional studies included a statement in their published report saying that that there was no difference in QoL between groups and one included a statement saying that results of QoL analyses were not reported in the manuscript. | ⨁◯◯◯ Very lowa,b,c | It is uncertain whether BNP-guided therapy improves quality of life because the quality of the evidence is very low. | |||