Daniels Lori B, Bhalla Vikas, Clopton Paul, Hollander Judd E, Guss David, McCullough Peter A, Nowak Richard, Green Gary, Saltzberg Mitchell, Ellison Stefanie R, Bhalla Meenakshi Awasthi, Jesse Robert, Maisel Alan
University of California at San Diego, California, USA.
J Card Fail. 2006 May;12(4):281-5. doi: 10.1016/j.cardfail.2006.01.008.
Previous studies have shown that in patients presenting to the emergency department (ED) with heart failure, there is a disconnect between the perceived severity of congestive heart failure (CHF) by physicians and the severity as determined by B-type natriuretic peptide (BNP) levels. Whether ethnicity plays a role in this discrepancy is unknown.
The Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) was a 10-center trial of 464 patients seen in the ED with acute dyspnea and BNP level higher than 100 pg/mL on arrival. Physicians were blinded to BNP levels. Patients were followed for 90 days after discharge. A total of 151 patients identified themselves as white (32.5%) and 294 as black (63.4%). Of these, 90% were hospitalized. African Americans were more likely to be perceived as New York Heart Association class I or II than whites (P = .01). Blacks who were discharged from the ED had higher median BNP levels than whites who were discharged (1293 vs. 533, P = .004). The median BNP of blacks who were discharged was actually higher than the median BNP of blacks who were admitted (1293 vs. 769, P = .04); the same did not hold true for whites. BNP was predictive of 90-day outcome in both blacks and whites; however, perceived severity of CHF, race, and ED disposition did not contribute to the prediction of events.
In patients presenting to the ED with heart failure, the disconnect between perceived severity of CHF and severity as determined by BNP levels is most pronounced in African Americans.
既往研究表明，因心力衰竭就诊于急诊科（ED）的患者中，医生所感知的充血性心力衰竭（CHF）严重程度与B型利钠肽（BNP）水平所确定的严重程度之间存在脱节。种族是否在这种差异中起作用尚不清楚。
快速急诊科心力衰竭门诊试验（REDHOT）是一项在10个中心开展的试验，纳入了464例因急性呼吸困难就诊于急诊科且入院时BNP水平高于100 pg/mL的患者。医生对BNP水平不知情。患者出院后随访90天。共有151例患者自认为是白人（32.5%），294例为黑人（63.4%）。其中，90%的患者住院治疗。非裔美国人比白人更有可能被认为是纽约心脏协会I级或II级（P = 0.01）。从急诊科出院的黑人的BNP中位数水平高于出院的白人（1293对533，P = 0.004）。出院黑人的BNP中位数实际上高于入院黑人的BNP中位数（1293对769，P = 0.04）；白人则并非如此。BNP可预测黑人和白人的90天结局；然而，CHF的感知严重程度、种族和急诊科处置情况对事件的预测并无贡献。
在因心力衰竭就诊于急诊科的患者中，CHF的感知严重程度与BNP水平所确定的严重程度之间的脱节在非裔美国人中最为明显。
