Natriuretic peptide‐guided treatment compared to standard care for the prevention of cardiovascular events in patients without heart failure

Patient or population: patients without heart failure
Setting: any
Intervention: natriuretic peptide‐guided treatment
Comparison: standard care

Cardiovascular mortality

Follow‐up: 2 years

RR 0.33
(0.04 to 3.17)

300
(1 RCT)

⊕⊕⊝⊝
LOW^a

Cardiovascular deaths not available, so cardiac deaths used

Cardiovascular hospitalisation (as defined by trialists)

Follow‐up range:

2 years to mean 4.2 years

RR 0.52
(0.40 to 0.68)

1674
(2 RCTs)

⊕⊕⊕⊝
MODERATE^b

All‐cause mortality
Follow‐up: range 2 years to mean 4.3 years

RR 0.90
(0.60 to 1.35)

1354
(2 RCTs)

⊕⊕⊝⊝
LOW^c,d

All‐cause hospitalisation (all occurrences)
Follow‐up: range 2 years to mean 4.3 years

RR 0.83
(0.75 to 0.92)

1354
(2 RCTs)

⊕⊕⊕⊝
MODERATE^b

Ventricular dysfunction (as defined by trialists)
Assessed with Doppler echocardiography
Follow‐up: mean 4.2 years

RR 0.61
(0.41 to 0.91)

1374
(1 RCT)

⊕⊕⊕⊕
HIGH^e

Ventricular dysfunction was defined by trialists as left ventricular dysfunction and heart failure. Left ventricular dysfunction (LVD) included all patients with asymptomatic left ventricular systolic dysfunction (LVSD) and/or asymptomatic left ventricular diastolic dysfunction (LVDD). Heart failure included all patients with LVD (LVSD and/or LVDD) and with symptoms of heart failure requiring emergency admission to hospital

Change in NP level at the end of follow‐up
Follow‐up: mean 4.2 years

‐

1374
(1 RCT)

⊕⊕⊕⊝
MODERATE^f

These data come from Ledwidge 2013; NP level was reported as BNP. Huelsmann 2013 also reported change in NT‐proBNP after 1 year of treatment. However, these data were presented as median and interquartile range; therefore we could not calculate mean difference

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence.
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.