Although we could not determine whether and how HF medication doses changed during follow up, the meta-analysis by Troughton et al. [9] showed no differences in medication dose changes between groups, except for a modest increase in doses of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARB) in the BNP-guided therapy group (8.4% increase, 3.4 to 13, vs. − 1.2% decrease, − 6.1 to 3.7 in the symptom-guided therapy group). This evidence concerns the gene NPPB and hydrops fetalis.