What is the quality of the clinical evidence regarding natriuretic peptide monitoring for heart failure?
The review identified multiple existing meta-analyses that pooled data from a number of heterogeneous trials investigating the effect of natriuretic peptide (NP) guided therapy. The use of individual patient data (IPD) in two of the existing meta-analyses provided a higher quality source of evidence than using the data reported by each individual study, and so this review utilised data from the existing IPD meta-analyses where possible. The trials included in the existing meta-analyses differed in patient population, baseline medication, NP guided protocol and control arm protocol. The review was unable to formally assess heterogeneity of the results split by age due to reliance on aggregate data from one of the existing meta-analyses, but the low levels of heterogeneity in the overall (not age- stratified) results gave the committee some confidence that considering the trials together was a valid approach.