Key result
Natriuretic peptide-guided therapy fails to reduce all-cause mortality versus usual care despite time-to-event benefit.
Why the study?
Natriuretic peptides are widely used to diagnose HF, but their role in guiding treatment remains uncertain.
Does natriuretic peptide-guided therapy reduce mortality and heart failure hospitalizations in patients with acute decompensated heart failure?
Meta-Analysis (n=3,992)
Does natriuretic peptide-guided therapy reduce mortality and heart failure hospitalizations in patients with acute decompensated heart failure?
Relative Risk: 0.84 (95% CI 0.69–1.01)
p-value: p=0.069
Natriuretic peptide-guided therapy in acute decompensated heart failure does not significantly reduce overall all-cause mortality, cardiovascular death, or the composite of HF hospitalization and cardiovascular death compared to usual care.
Background Natriuretic peptides (NP) are widely used to diagnose heart failure (HF), but their role in guiding treatment remains uncertain. We performed a randomized trial meta‐analysis comparing NP‐guided therapy to usual care in acute decompensated HF. Methods We searched PubMed, Embase, and Cochrane for RCTs comparing NP‐guided therapy to usual care in acute decompensated HF. Outcomes included all‐cause mortality, cardiovascular death, and a composite of mortality and HF hospitalizations (reported as RR and 95% CI). Heterogeneity was assessed using I 2 , and a random‐effects model was applied when appropriate. Analyses were performed in R Studio 4.3.2. Results We included 9 RCTs with 3992 patients, of whom 2007 (50.3%) underwent NP‐guided treatment. The median follow‐up was 12 months. All‐cause mortality (RR: 0.84; 95% CI: 0.69–1.01; p = 0.069; I 2 = 41%), cardiovascular death (RR: 0.91; 95% CI: 0.78–1.08; p = 0.287; I 2 = 0%), and the composite outcome of HF hospitalization or cardiovascular death (RR: 0.91; 95% CI: 0.77–1.09; p = 0.308; I 2 = 56%) were not significantly different between groups. The time to event analysis of all‐cause mortality had a slightly significant advantage in favor of NP‐guided therapy (HR: 0.81; 95% CI: 0.69–0.95; p = 0.01; I 2 = 0%). Conclusion Although NP‐guided therapy showed a statistically significant benefit in time to all‐cause mortality, this was not consistently reflected across other endpoints, and its overall clinical impact remains uncertain.
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Gioli‐Pereira et al. (2025) conducted a meta-analysis in acute decompensated heart failure (n=3,992). Natriuretic peptide-guided therapy vs. usual care was evaluated on all-cause mortality (RR 0.84, 95% CI 0.69-1.01, p=0.069). Natriuretic peptide-guided therapy did not significantly reduce all-cause mortality (RR 0.84; 95% CI 0.69-1.01; p=0.069), though time-to-event analysis showed a benefit (HR 0.81; p=0.01).
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