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Abstract：
GUIDE-IT, the largest trial to date, published in August 2017, evaluating the effectiveness of natriuretic peptide (NP)-guided treatment of heart failure (HF), was stopped early for futility on a composite outcome. However, the reported effect sizes on individual outcomes of all-cause mortality and HF admissions are potentially clinically relevant.
This systematic review and meta-analysis aims to combine all available trial level evidence to determine if NP-guided treatment of HF reduces all-cause mortality and HF admissions in patients with HF.
Eight databases, no language restrictions, up to November 2017 were searched for all randomised controlled trials comparing NP-guided treatment versus clinical assessment alone in adult patients with HF. No language restrictions were applied. Publications were independently double screened and extracted. Fixed-effect meta-analyses were conducted.
89 papers were included, reporting 19 trials (4554 participants), average ages 62-80 years. Pooled risk ratio estimates for all-cause mortality (16 trials, 4063 participants) were 0.87, 95% CI 0.77 to 0.99 and 0.80, 95% CI 0.72 to 0.89 for HF admissions (11 trials, 2822 participants). Sensitivity analyses, restricted to low risk of bias, produced similar estimates, but were no longer statistically significant.
Considering all the evidence to date, the pooled effects suggest that NP-guided treatment is beneficial in reducing HF admissions and all-cause mortality. However, there is still insufficient high-quality evidence to make definitive recommendations on the use of NP-guided treatment in clinical practice.
Systematic Review Cochrane Database Number: CD008966.
This systematic review and meta-analysis aims to combine all available trial level evidence to determine if NP-guided treatment of HF reduces all-cause mortality and HF admissions in patients with HF.
Eight databases, no language restrictions, up to November 2017 were searched for all randomised controlled trials comparing NP-guided treatment versus clinical assessment alone in adult patients with HF. No language restrictions were applied. Publications were independently double screened and extracted. Fixed-effect meta-analyses were conducted.
89 papers were included, reporting 19 trials (4554 participants), average ages 62-80 years. Pooled risk ratio estimates for all-cause mortality (16 trials, 4063 participants) were 0.87, 95% CI 0.77 to 0.99 and 0.80, 95% CI 0.72 to 0.89 for HF admissions (11 trials, 2822 participants). Sensitivity analyses, restricted to low risk of bias, produced similar estimates, but were no longer statistically significant.
Considering all the evidence to date, the pooled effects suggest that NP-guided treatment is beneficial in reducing HF admissions and all-cause mortality. However, there is still insufficient high-quality evidence to make definitive recommendations on the use of NP-guided treatment in clinical practice.
Systematic Review Cochrane Database Number: CD008966.
摘要：
GUIDE-IT,迄今为止最大的审判,发表于2017年8月，评估利钠肽（NP）指导治疗心力衰竭（HF）的有效性，因复合结果无效而提前停止。然而,报告的对全因死亡率和HF入院的个体结局的影响大小可能具有临床意义.
本系统评价和荟萃分析旨在结合所有可用的试验水平证据，以确定NP指导的HF治疗是否能降低HF患者的全因死亡率和HF入院率。
八个数据库，没有语言限制，截至2017年11月,我们检索了所有随机对照试验,比较了NP指导治疗与单纯临床评估对成年HF患者的影响.未应用语言限制。独立地对出版物进行双重筛选和提取。进行固定效应荟萃分析。
89篇论文被收录，报告19项试验（4554名参与者），平均年龄62-80岁。全因死亡率的集合风险比估计(16项试验，4063名参与者）的HF入院为0.87，95％CI0.77至0.99和0.80，95％CI0.72至0.89（11项试验，2822名与会者)。敏感性分析，限于低偏见风险，产生了类似的估计，但不再具有统计学意义。
考虑到迄今为止所有的证据,综合效应提示NP指导治疗有利于降低HF入院率和全因死亡率.然而,目前仍没有足够的高质量证据就NP指导治疗在临床实践中的使用提出明确的建议.
系统评价Cochrane数据库编号：CD008966。
本系统评价和荟萃分析旨在结合所有可用的试验水平证据，以确定NP指导的HF治疗是否能降低HF患者的全因死亡率和HF入院率。
八个数据库，没有语言限制，截至2017年11月,我们检索了所有随机对照试验,比较了NP指导治疗与单纯临床评估对成年HF患者的影响.未应用语言限制。独立地对出版物进行双重筛选和提取。进行固定效应荟萃分析。
89篇论文被收录，报告19项试验（4554名参与者），平均年龄62-80岁。全因死亡率的集合风险比估计(16项试验，4063名参与者）的HF入院为0.87，95％CI0.77至0.99和0.80，95％CI0.72至0.89（11项试验，2822名与会者)。敏感性分析，限于低偏见风险，产生了类似的估计，但不再具有统计学意义。
考虑到迄今为止所有的证据,综合效应提示NP指导治疗有利于降低HF入院率和全因死亡率.然而,目前仍没有足够的高质量证据就NP指导治疗在临床实践中的使用提出明确的建议.
系统评价Cochrane数据库编号：CD008966。
