Abstract 4144815: Natriuretic peptide-guided therapy in acute decompensated heart failure: An updated systematic review and meta-analysis

Background: Natriuretic peptides (NP) are frequently employed in diagnosing heart failure (HF); however, their effectiveness in guiding HF treatment lacks sufficient evidence. To address this gap, we conducted an updated meta-analysis assessing the efficacy of NP-guided therapy versus usual care in decompensated HF. Methods: PubMed, Embase and Cochrane database were searched for randomized controlled trials (RCTs) that compared NP-guided treatment to usual care for patients with acute decompensated heart failure. The reported outcomes were (1) all-cause mortality; (2) cardiovascular death; and a (3) composite of all-cause mortality and HF hospitalizations. Heterogeneity was examined with I 2 statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was done using R Studio 4.3.2. Results: We included 10 RCTs with 4122 patients, of whom 2072 (50.3%) underwent NP-guided treatment. Mean follow-up was 14.8 months. All-cause mortality (HR 1.03; 95% CI 0.81-1.32; p=0.79; figure 1A), cardiovascular death (HR 1.33; 95% CI 0.72-2.47; p=0.36; figure 1B), and the composite outcome of HF hospitalization or cardiovascular death (HR 0.92; 95% CI 0.77-1.11; p=0.4; figure 1C) were not significantly different between groups. Conclusion: These findings suggest that NP-guided therapy does not reduce mortality and heart failure readmissions in the management of patients with acute decompensated heart failure.