This aligned with subgroup analyses reported in the existing meta-analyses, 279 55 which showed that the mortality and all- cause hospitalisation benefit of NP monitoring was found in HFREF but not HFPEF patients. For these reasons, the committee decided that the recommendation should be limited to people with HFREF. People with heart failure and chronic kidney disease The committee considered the evidence regarding the use of NP-guided treatment strategies in patients with HF and CKD and agreed that although there was suggestion of a clinically important increase in deaths (9 more (from 105 fewer to 172 more)) these results were imprecise making it difficult for the committee to have confidence in the results. In addition to this there was inconsistency in the results reported for people with HFREF and HFpEF which further reduced the committees confidence in the results. Regardless of this the committee agreed that the evidence may be suggestive of a clinically significant increase in deaths with NP monitoring and therefore people with HF and CKD should be monitored by a specialist. The committee noted the findings of the separate review of pharmaceutical treatment for HF in people with both HF and CKD, which generally concluded that most patients with CKD should be offered the same treatment options as patients without CKD. The committee noted that while the patients with CKD in the original trials made up more than half the total number of participants, many of the included studies excluded patients with severe renal disease with the majority of patients included in the trials having an eGFR of . Therefore, the results cannot be extrapolated to patients with more severe CKD. People with heart failure and atrial fibrillation The committee discussed NP monitoring in patients with HF and AF. 