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The role of natriuretIc peptides in the management and prognosis of heart failure

Research recommendation/question:
What is the optimal use of natriuretic peptides in the management and prognostic stratification of patients with heart failure?
PopulationInterventionComparisonOutcomes
Heart failureNatriuretic peptidesClinical careMortality (all cause, heart failure)
Hospitalisation (heart failure, all cause, planned, unplanned)
Change in NYHA class
Quality of life
Why this is important
Heart failure is characterised by repeated hospitalisation, high mortality in the period immediately following hospitalisation and an unpredictable course in the later stages. In people with heart failure natriuretic peptide levels have been shown to correlate with poor prognosis. Studies of the use of natriuretic peptides to guide drug titration have suggested a potential reduction in mortality in some groups, although the overall utility of this remains uncertain in the broader population with heart failure. Research is needed in three areas:
  • Whether elevated natriuretic peptides despite maximum tolerated therapy could be used to predict prognosis and to guide an ‘end-of-life’ strategy for late-stage heart failure.
  • Whether the level of natriuretic peptides at the time of discharge could be used to prioritise routine follow-up after discharge.
  • Whether routine monitoring of natriuretic peptides in people with heart failure in the community might allow optimal use of community nursing resources.

From: 9, Research recommendations

Cover of Chronic Heart Failure
Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update [Internet].
NICE Clinical Guidelines, No. 108.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guideline Centre.

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