Essential components in natriuretic peptide-guided management of heart failure: an intervention synthesis
| Autor: | A Clements, Graeme T. Spence, Clare J Taylor, Amitava Banerjee, Julie McLellan, Jason Oke, Clare Bankhead, Rafael Perera |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class Management of heart failure Psychological intervention heart failure 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine systematic review Intervention (counseling) Natriuretic peptide medicine Credible interval In patient 030212 general & internal medicine Intensive care medicine Heart Failure and Cardiomyopathies business.industry Univariate medicine.disease monitoring Heart failure Cardiology and Cardiovascular Medicine business natriuretic peptides |
| Zdroj: | Open Heart |
| ISSN: | 2053-3624 |
| Popis: | AimTo identify the key components of natriuretic peptide (NP)-guided treatment interventions which reduced hospitalisation in patients with heart failure (HF).Methods and resultsWe 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.ConclusionThis 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|