DynaMed Weekly Update

October 27, 2009

Volume 4 Issue 43

DynaMed Systematic Literature Surveillance

For the week ending October 23, 2009

Last week 776 articles were evaluated via DynaMed’s Systematic Literature Surveillance and 336 were added to DynaMed content.

Based on the editors’ criteria of selecting “articles most likely to change clinical practice,” one article of significant interest was selected for the DynaMed Weekly Update.

BNP and NT-proBNP-guided Treatment Reduces Mortality in Patients with Chronic Heart Failure

B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) can give useful diagnostic and prognostic information in patients with acute dyspnea and chronic heart failure. Prognosis tends to be better in patients with decreasing BNP levels in response to treatment. A new systematic review provides evidence that medical treatment titrated in accordance with BNP or NT-proBNP levels reduces mortality in chronic heart failure (level 1 [likely reliable] evidence). BNP-guided treatment was compared to usual care guided primarily by clinical symptoms in 1,627 patients with heart failure. Follow-up ranged from 6-18 months. BNP-guided treatment was associated with a significant reduction in all-cause mortality (hazard ratio 0.69, 95% CI 0.55-0.86), with a NNT of 12-40 for 1 year assuming 80% survival in the control group. The benefit was found primarily in patients < 75 years old in 2 trials that stratified patients by age. BNP-guidance was associated with increased use of ACE inhibitors, angiotensin receptor blockers, beta blockers, and aldosterone antagonists but not diuretics (Am Heart J 2009 Sep;158(3):422).

For more information, see the Brain natriuretic peptide (BNP) testing topic in DynaMed.

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DynaMed Topic Activity

New summary added to DynaMed this week:

· Asthma during pregnancy

DynaMed Peer Review

We are currently seeking reviewers for:

· Atrophic vaginitis

· Brown recluse spider bite

· Prenatal ultrasound screening

For more information, see Editorial Policies for Authors & Reviewers and DynaMed Peer Review.

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DynaMed Weekly Update Archives

DynaMed Weekly Update is a compilation of 1 to 5 articles that are of significant interest to clinicians. Articles are selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice. Updates are prepared by the DynaMed Editorial Team which includes 28 clinicians from multiple disciplines. Send comments to DynaMedEditor@epnet.com. To learn more about DynaMed, go to www.dynamicmedical.com.

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Copyright © 2009 EBSCO Publishing. All rights reserved.
DynaMed® is a registered trademark of and published by DynaMed LLC. Original date of on-line publication December 15, 1995 with continuous daily updating. ISSN: 1554-1177. Subscriptions and queries can be addressed to DynaMed LLC, EBSCO Publishing, 10 Estes St., Ipswich, Massachusetts, USA 01938-0602, telephone (978) 356-6500, facsimile (978) 356-6565, e-mail Editor@DynamicMedical.com. The opinions expressed herein are solely those of the authors and editors and may or may not represent the official position of cooperating or endorsing Medical Societies. Development of DynaMed was supported in part by the National Science Foundation through a Small Business Innovative Research grant. (All other support comes from subscriptions. No advertisements are accepted.)