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Systematic review with meta-analysis
B-type natriuretic peptide-guided therapy for chronic heart failure reduces all-cause mortality compared with usual care but does not affect all-cause hospitalisation or survival free of hospitalisation
  1. A Mark Richards
  1. Cardioendocrine Research Group, University of Otago, Christchurch, New Zealand
  1. Correspondence to A Mark Richards
    Cardiovascular Research Institute, National University Heart Centre , Singapore 1 E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore 119228; mdcarthu{at}nus.edu.sg

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Despite advances in drug and device therapy, after admission and treatment for acute heart failure (HF), 30% of patients are readmitted and 10% die within 90 days. This partly reflects imperfect implementation of proven therapies with surveys indicating only a minority of patients receive target doses of effective medications.

The gap in guiding HF treatment

In turn, this reflects the absence of an objective measure of adequacy of treatment. After overt signs and symptoms of cardiac decompensation resolve, the clinician has no clear guide for titration of therapy. Plasma B-type natriuretic peptide (BNP/NTproBNP) levels may fill this gap. BNP/NTproBNP independently indicate prognosis at all grades of HF and parallel response to effective therapies. Hence, they may allow individual tailoring of treatment with the possibility of better outcomes.

Porapakkham and colleagues have conducted a metaanalysis of prospective randomised controlled trails comparing BNP-guided therapy with standard care. In …

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