BMJ 2005;330:625 (19 March), doi:10.1136/bmj.330.7492.625
Paper
How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review
Jenny A Doust, senior research fellow1,
Eva Pietrzak, senior research officer2,
Annette Dobson, professor of biostatistics2,
Paul Glasziou, director3
1 Centre for General Practice, School of Medicine, University of Queensland,
Herston Road, Herston, Qld 4006, Australia,
2 School of Population Health, University of Queensland,
3 Centre for Evidence-Based Medicine, Department of Primary Health Care,
University of Oxford, Oxford
Correspondence: J Doust
j.doust{at}sph.uq.edu.au
Objective To assess how well B-type natriuretic peptide (BNP)
predicts prognosis in patients with heart failure.
Design Systematic review of studies assessing BNP for prognosis in
patients with heart failure or asymptomatic patients.
Data sources Electronic searches of Medline and Embase from January
1994 to March 2004 and reference lists of included studies.
Study selection and data extraction We included all studies that
estimated the relation between BNP measurement and the risk of death, cardiac
death, sudden death, or cardiovascular event in patients with heart failure or
asymptomatic patients, including initial values and changes in values in
response to treatment. Multivariable models that included both BNP and left
ventricular ejection fraction as predictors were used to compare the
prognostic value of each variable. Two reviewers independently selected
studies and extracted data.
Data synthesis 19 studies used BNP to estimate the relative risk of
death or cardiovascular events in heart failure patients and five studies in
asymptomatic patients. In heart failure patients, each 100 pg/ml increase was
associated with a 35% increase in the relative risk of death. BNP was used in
35 multivariable models of prognosis. In nine of the models, it was the only
variable to reach significancethat is, other variables contained no
prognostic information beyond that of BNP. Even allowing for the scale of the
variables, it seems to be a strong indicator of risk.
Conclusion Although systematic reviews of prognostic studies have
inherent difficulties, including the possibility of publication bias, the
results of the studies in this review show that BNP is a strong prognostic
indicator for both asymptomatic patients and for patients with heart failure
at all stages of disease.

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