ISBN: 978-1-4731-3093-7 8.2.4 Economic evidence Published literature No previously published economic evidence was identified for this question in the review. See also the health economic study selection flow chart in Appendix D. 8.2.5 Evidence statements Clinical Subgroup analyses in one primary study and one systematic review (which included an IPD meta- analysis of seven studies) were identified for inclusion within the review. All of the included studies compared repeated biomarker measurement (BNP or NT-proBNP) with clinical monitoring in people with HF who also have CKD. The quality of the evidence was very low as a result of risk of bias, imprecision due to wide confidence intervals surrounding the effect estimate, indirectness of the outcome and inconsistency due to heterogeneity in the results reported by individual studies. Mortality did not demonstrate a clear effect with the confidence interval ranging from a decrease and increase in all-cause mortality.The outcome all-cause hospitalisations (as measured by days in hospital) suggested no clinical effect of NP monitoring. Economic No economic evaluations were identified. 8.3 Monitoring using repeated biomarker measurement or imaging for management of chronic heart failure in people who also have atrial fibrillation Atrial fibrillation (AF) is an abnormal heart rhythm affecting 2-3% of the adult population but is more common in patients with HF. Patients may be aware of palpitations, fatigue or breathlessness although many are asymptomatic. AF may be detected on examination, with an irregular pulse, and confirmed by ECG. The treatment of AF includes rate and rhythm control as well as anticoagulation to reduce the stroke risk. The management of AF is covered by NICE guideline CG180. Biomarkers are substances measurable in the blood stream which can be used to diagnose and monitor disease. Natriuretic peptides are released from the myocardium in response to fluid overload. 