Eight RCTs (n=1,726 patients, sample size range 41 to 499) were included in the meta-analysis. Mean duration of follow-up was 17 months (range three to 24 months).
A statistically significant lower risk of all-cause mortality was reported following BNP-guided treatment (RR 0.76, 95% CI 0.63 to 0.91; eight trials). The effect size was influenced by one trial that contributed nearly 50% of the weight. When this trial was excluded in the sensitivity analysis, relative risk became non-significant (RR 0.76, 95% CI 0.58 to 1.00).
In a subgroup analyses of two trials, all-cause mortality remained significantly lower in younger patients (<75 years) who received BNP-guided treatment (RR 0.52, 95% CI 0.33 to 0.82). There was no difference in outcome between modes of care in older patients. There were no statistically significant differences between groups for hospitalisation (three trials) and survival free of any hospitalisation (two trials).
There was no statistically significant heterogeneity in any of the analyses. Publication bias was considered not to be influential.
Other results outside the meta-analysis showed no statistically significant differences in terms of number of days alive and not hospitalised (two trials). Patients in the BNP-guided treatment group were more likely to have their heart failure medications (ACE inhibitors and beta-blockers) increased (two trials). Twice as many patients in the BNP-guided treatment group reached their target treatment levels compared with those who received usual care (two trials).