Bias in natriuretic peptide-guided heart failure trials: time to improve guideline adherence using alternative approaches

Susan Stienen, Ankeet Bhatt, João Pedro Ferreira, Muthiah Vaduganathan, James Januzzi, Kirkwood Adams, Jean-Claude Tardif, Patrick Rossignol, Faiez Zannad

Research output: Contribution to JournalReview articleAcademicpeer-review

1 Citation (Scopus)


Treatment of patients with heart failure with reduced ejection fraction (HFrEF) with currently available therapies reduces morbidity and mortality. However, implementation of these therapies is a problem with only few patients achieving guideline-recommended maximal doses of therapy. In an effort to improve guideline adherence and uptitration, several trials have investigated a biomarker-guided strategy (using natriuretic peptide targets in specific), but although conceptually promising, these trials failed to show a consistent beneficial effect on outcomes. In this review, we discuss different methodological issues that may explain the failure of these trials and offer potential solutions. Moreover, alternative approaches to increase heart failure guideline adherence are evaluated.
Original languageEnglish
Pages (from-to)11-21
Number of pages11
JournalHeart failure reviews
Issue number1
Early online date2020
Publication statusPublished - Jan 2021


  • Adherence
  • Bias
  • Biomarker
  • Biomarker-guided trials
  • Guideline-directed
  • HFrEF
  • Medical therapy
  • Natriuretic peptides

Cite this