Oke, J;
Clements, A;
McLellan, J;
Bankhead, C;
Taylor, CJ;
Spence, G;
Banerjee, A;
(2018)
Essential components in natriuretic peptide-guided management of heart failure: an intervention synthesis.
Open Heart
, 5
(2)
, Article e000826. 10.1136/openhrt-2018-000826.
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Abstract
AIM: 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 eight 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. Using a predefined treatment protocol, setting a stringent NP target (N-terminal pro-B-type natriuretic peptide of 1000 pg/mL or B-type natriuretic peptide 100 pg/mL) and including a relative targetwere potential 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.
| Type: | Article |
|---|---|
| Title: | Essential components in natriuretic peptide-guided management of heart failure: an intervention synthesis |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1136/openhrt-2018-000826 |
| Publisher version: | http://dx.doi.org/10.1136/openhrt-2018-000826 |
| Language: | English |
| Additional information: | © Author(s) (or their employer[s]) 2018. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported license (http://creativecommons.org/licenses/by/4.0). |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10061222 |
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