See also the health economic study selection flow chart in Appendix D. 8.3.5 Evidence statements Clinical No relevant clinical evidence was identified for inclusion within this review. Economic No economic evaluations were identified. 8.3.6 Recommendations and link to evidence Recommendations Consider measuring NT-proBNP (N-terminal pro-B-type natriuretic peptide) as part of a treatment optimisation protocol only in a specialist care setting for people aged under 75 who have heart failure with reduced ejection Relative values of different outcomes The critical outcomes were identified as mortality, all-cause hospitalisations and quality of life. Important outcomes were adverse events that could be related to treatment: bradycardia, hypotension, impaired renal function, hyperkalaemia, arrhythmic events. The committee sought evidence that stratified the results by age, as it was expected that older people (on average) may not respond as well to more intensive treatment regimes. Quality of the clinical evidence Natriuretic peptide monitoring General heart failure population: 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. Chronic Heart Failure Monitoring NICE 2018. All rights reserved. 