Background <p>Carperitide, which is an α-human A-type natriuretic peptide, is used intravenously for the treatment of acute heart failure (AHF) primarily in Japan. However, its clinical effectiveness has not been established. The aim of this meta-analysis was to assess the effect of carperitide on the clinical outcomes of patients with AHF.</p> Methods <p>We searched the MEDLINE, ICHUSHI, Cochrane Library and Web of Science databases using a defined search strategy to identify eligible randomized controlled trials (RCTs) and propensity score matching (PSM) studies. The primary outcome was in-hospital mortality. The secondary outcomes were long-term mortality, HF rehospitalization, length of hospital stay and hypotension. Pooled odds ratios (ORs)/mean differences and 95% confidence intervals (CIs) were calculated by using the random effects model.</p> Results <p>A total of nine studies were evaluated in the meta-analysis, including four RCTs and five PSM studies. A meta-analysis of RCTs and PSM studies revealed that the in-hospital mortality rate was higher in the carperitide group than in the noncarperitide group (OR 1.38; 95% CI 1.07–1.78; I² = 77%). However, a meta-analysis of the RCTs alone revealed no significant difference in in-hospital mortality (OR 0.85; 95% CI: 0.07–10.49; I² = 39%). There were no significant differences observed between the two groups in terms of long-term mortality, HF rehospitalization, incidence of hypotension, or length of hospital stay.</p> Conclusions <p>This meta-analysis suggested that carperitide therapy may not be superior to noncarperitide therapy in terms of reducing in-hospital mortality rates or improving long-term outcomes in patients with AHF.</p> Trial registration <p>The review protocol was registered in PROSPERO (ID: CRD420251071777).</p>