Natriuretic Peptide Testing for Monitoring of Heart Failure Therapy: A Review of Clinical Effectiveness, Clinical Utility, Cost-Effectiveness, and Guidelines

Key Message

Four relevant systematic reviews were identified. Three systematic reviews showed that the between group differences for natriuretic peptide (NP)-guided therapy compared with clinically-guided therapy for heart failure (HF) patients were statistically significant with respect to HF-related hospitalization, favoring NP-guided therapy. However some uncertainty remains as in two of the three systematic reviews, the confidence intervals indicated marginal significance. Overall for the other outcomes (all-cause mortality, HF-related mortality, all cause hospitalization, and quality of life), there were no statistically significant between group differences for NP-guide therapy compared with clinically-guided therapy for HF patients. Overall the clinical effectiveness and clinical utility of the use of NP-guided therapy for HF patients remains uncertain.One economic evaluation showed that NP-guided therapy appeared to be cost-effective for patients, who were less than 75 years of age and with heart failure with reduced ejection fraction considering a willingness-to-pay threshold of £20,000 and if NP-guided therapy is considered effective.Two guidelines suggested that NP-guided therapy may be considered for HF patients less than 75 years of age (one guideline mentioned that the recommendation was weak, and another guideline did not specify the strength of the recommendation).