ISBN: 978-1-4731-3093-7 Table 84: PICO characteristics of review question Population People diagnosed with heart failure in a community or outpatient setting who also have chronic kidney disease Aged under 75 years Aged 75 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 8.2.3 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, that had a population or subgroup with chronic kidney disease. Subgroup analyses in one primary study 114 and one systematic review 55, 338 , including an individual patient data meta-analysis of seven studies, were included in the review. These are summarised in Table 85 and Table 86, and the clinical evidence is summarised in Table 87. See also the study selection flow chart in 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. Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. 