Key result
Natriuretic peptide-guided heart failure trials failed to show consistent beneficial effects on outcomes, likely due to internal contamination bias and overoptimistic sample size estimations.
Why the study?
Biomarker-guided heart failure trials targeting natriuretic peptides have failed to demonstrate a consistent beneficial effect on outcomes despite poor implementation of guideline-recommended therapies in HFrEF.
This review highlights methodological flaws in natriuretic peptide-guided heart failure trials and suggests alternative approaches to improve guideline adherence.
Does not support natriuretic peptide-guided therapy in heart failure; leaves open refined trial designs addressing contamination bias.
Treatment of patients with heart failure with reduced ejection fraction (HFrEF) with currently available therapies reduces morbidity and mortality. However, implementation of these therapies is a problem with only few patients achieving guideline-recommended maximal doses of therapy. In an effort to improve guideline adherence and uptitration, several trials have investigated a biomarker-guided strategy (using natriuretic peptide targets in specific), but although conceptually promising, these trials failed to show a consistent beneficial effect on outcomes. In this review, we discuss different methodological issues that may explain the failure of these trials and offer potential solutions. Moreover, alternative approaches to increase heart failure guideline adherence are evaluated.
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Stienen et al. (2020) conducted a review in Heart failure with reduced ejection fraction (HFrEF). Natriuretic peptide-guided therapy vs. Standard of care was evaluated. Natriuretic peptide-guided heart failure trials failed to show consistent beneficial effects on outcomes, likely due to internal contamination bias and overoptimistic sample size estimations.
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