ISBN: 978-1-4731-3093-7 Study Intervention and comparison (in HF clinic unless stated otherwise) Population Outcomes Comments Stratified by LVEF status UPSTEP trial: Karlstrom (Karlstrom , Karlstrom ) NP monitoring: Therapy increased towards guideline- target doses to reach BNP Clinical monitoring: Therapy intensified at clinician s discretion according to clinical assessment Age > 18 years, LVEF < 40%, NYHA class II-IV, worsening HF (requiring hospitalisation and/or IV support) Elevated BNP those aged < 75 years and > 300 ng/L for those aged > 75 years) despite standard treatment with ACEi/ARB and BB HTA IPD: All-cause admission by age Study papers: Quality of life Recruited ACEi/ARB: Angiotensin converting enzyme inhibitor and/or Aldosterone receptor blocker, BB: Beta-blocker, IV: Intravenous therapy, NP: natriuretic peptides including BNP and NT-proBNP Monitoring Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: Table 81: Clinical evidence summary: NP monitoring versus clinical monitoring Outcomes No of Participants (studies) Follow up Quality of the evidence (GRADE) Relative effect Anticipated absolute effects Risk with Clinical monitoring Risk difference with NP monitoring (95% CI) Mortality (HR) - Age <75 years 1234 LOWb,c,g due to risk of bias, imprecision Estimatea (from 103 fewer to 0 more) Mortality (HR) - Age 75 and over LOWb,c,g due to risk of bias, imprecision Estimatea (from 56 fewer to 200 more) Mortality (RR) - All ages 946 LOWb,c due to risk of bias, imprecision (from 50 fewer to 26 more) All-cause hospitalisation (HR) - Age <75 years MODERATEc due to imprecision Estimatee (from 4 fewer to 152 fewer) All-cause hospitalisation (HR) - Age 75 and over MODERATEc due to imprecision Estimatee (from 64 fewer to 83 more) All-cause hospitalisation (RR) - All ages LOWb,c due to risk of bias, imprecision (from 180 fewer to 66 more) All-cause hospitalisation (Rate Ratio) - All ages VERY LOWb,c due to risk of bias, imprecision Rate Ratio 694 events per 1000 person- years 181 fewer events per 1000 person years (from 417 fewer to 257 more) HF hospitalisation (HR) - All ages VERY LOWb,c,d due to risk of bias, Estimatef (from 2 fewer to 87 fewer) Monitoring Chronic Heart Failure NICE 2018. 