Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 8.1.5 Evidence statements Clinical Seventeen studies, comparing repeated biomarker measurement (BNP or NT-proBNP) with usual care (either protocol driven or not protocol driven and without repeated measurement) in people with heart failure were identified for inclusion within the review. The quality of the evidence ranged from moderate to very low. Evidence was downgraded for a number of reasons including risk of bias, imprecision due to wide confidence intervals surrounding the effect estimate, indirectness of the reported outcomes, and inconsistency due to heterogeneity in the effect estimates reported by the studies. Outcomes were stratified by age (<75 years and 75 years) where the study had reported this. NP monitoring versus clinical monitoring All ages: Moderate quality evidence was found for the outcomes QoL as measured by the MLWHFQ (n=462) and the SF-36 mental component summary (n=418) both of which suggested no clinical effect of NP monitoring. Further moderate quality evidence was found for the outcome renal function as measured by eGFR, creatinine clearance and creatinine level (n=654) which also suggested no clinical effect of NP monitoring. Low quality evidence was found for the outcomes mortality (n=946) and hospitalisations (RR)(n=220), there was a reduction in hosptilisations suggesting a clinical benefit of NP monitoring (associated with wide confidence intervals around the effect estimate). Mortality did not demonstrate a clear effect with the confidence interval ranging from a decrease and increase in all-cause mortality. Low quality evidence was also found for the outcomes QoL as measured by the KCCQ (n=250), worsening renal function (n=849), hypotension (n=1114) and atrial fibrillation (n=151) all of which showed no clinical effect of NP monitoring. 