Table 78: PICO characteristics of review question Population People diagnosed with heart failure in a community or outpatient setting. Age under 75 years Aged 75 years and over Interventions Biomarker monitoring: serial (protocol-driven) measurements of circulating biomarker concentration: NT-proBNP (alone) BNP (alone) Troponin (alone) Combination of 2 biomarkers Combination of all 3 biomarkers Imaging monitoring: serial (protocol-driven) cardiac MRI Imaging monitoring: serial (protocol-driven) echocardiography Comparisons Each other Usual care: Clinical monitoring (protocol-driven) Usual care: Clinical monitoring (not protocol-driven) Outcomes CRITICAL Mortality (Time to event) Quality of life at 12 months (Continuous) Unplanned hospitalisation (all-cause) (Count rate) IMPORTANT Adverse events - hypotension (Dichotomous) Adverse events - hyperkalaemia (Dichotomous) Adverse events - renal function (Continuous) Adverse events - bradycardia (Dichotomous) Adverse events - arrhythmic events (Dichotomous) Study design Systematic reviews of RCTs RCTs 8.1.3 Clinical evidence A search was conducted for randomised trials and systematic reviews of randomised trials comparing the effectiveness of monitoring with repeated biomarker measurement (BNP, NT-proBNP or troponin) or repeated cardiac imaging (echocardiography or cardiac MRI), compared to usual care without repeated measurement or imaging. were included in the review, as well as three systematic reviews (4 providing additional information on some of the primary studies these are summarised in Table 79 and Table 80 below. See also the study selection flow chart in Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Appendix C, forest plots in Appendix E, study evidence tables in Appendix F, GRADE tables in Appendix H and excluded studies list in Appendix I. All of the 14 studies involved repeated BNP or NT-proBNP (together called NP) biomarker testing. No relevant studies comparing usual care with troponin or combinations of different biomarkers were identified. No relevant studies comparing usual care with routine cardiac imaging were identified. 