Prediction of clinical outcomes using B-type natriuretic peptides in the general population: a systematic review

Heart Fail Rev. 2014 Aug;19(4):541-51. doi: 10.1007/s10741-014-9446-7.

Abstract

The use of B-type natriuretic peptides to predict outcomes in general populations has been investigated in a number of primary studies. A previous systematic review considering natriuretic peptides in cardiovascular disease included a subgroup of general population studies, which suggested an association with a number of clinical outcomes. We electronically searched Medline, Embase, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL for English-language articles published between 1989 and mid-2012. We utilized trained reviewers and standardized forms to screen articles for inclusion and extract data from included articles. All included studies (n = 7) were summarized in narrative and tabular form. A general population was defined as one that was randomly selected from a community setting where no specific inclusion or exclusion criteria were specified. The seven included studies all used FDA approved assays for NT-proBNP. The range of clinical outcomes and heterogeneity did not allow for meta-analysis. The hazard ratios for predicting outcomes in the included studies ranged from 1.0 to 4.1 (all p values <0.05). The discrimination statistics reported in four studies all demonstrated statistically significant improvements in predicting outcomes. NT-proBNP is associated with heart failure, all-cause and cardiovascular mortality, and other combined cardiovascular events in a general unselected population. The discrimination statistics suggest modest improvements in risk stratification. No prospective studies exist to demonstrate the clinical utility of using B-type natriuretic peptides to predict clinical outcomes in a general population.

Publication types

  • Research Support, N.I.H., Extramural
  • Systematic Review

MeSH terms

  • Disease Management*
  • Global Health
  • Heart Failure* / blood
  • Heart Failure* / epidemiology
  • Heart Failure* / therapy
  • Humans
  • Morbidity
  • Natriuretic Peptide, Brain / blood*
  • Prognosis
  • Survival Rate

Substances

  • Natriuretic Peptide, Brain