Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Baim Institute for Clinical Research, Boston, MA, USA.
ESC Heart Fail. 2022 Feb;9(1):87-99. doi: 10.1002/ehf2.13749. Epub 2021 Dec 16.
The N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a commonly used biomarker in heart failure for diagnosis and prognostication. We aimed to determine the prevalence of NT-proBNP testing, distribution of NT-proBNP concentrations, and factors associated with receiving an NT-proBNP test in patients with heart failure with reduced ejection fraction (HFrEF), including the subset with a worsening heart failure event (WHFE).
This was a retrospective cohort study using two US databases: (i) the de-identified Humana Research Database between January 2015 and December 2018 and (ii) the Veradigm PINNACLE Registry between July 2013 and September 2017. We included adult patients with a confirmed diagnosis of HFrEF. In each data source, a subgroup of patients with a WHFE was identified, where a WHFE was defined as a heart failure-related hospitalization or receipt of intravenous diuretics. Bivariate and multivariate analyses were conducted to assess factors associated with receiving NT-proBNP testing. In Cohort 1 (n = 249 238), 9.2% of patients with HFrEF and 10.8% of patients with a WHFE received NT-proBNP testing. When restricted to patients with at least one laboratory claim, 11.3% of patients with HFrEF and 13.2% of those with a WHFE received NT-proBNP testing. In Cohort 2 (n = 91 444), 2.3% of patients with HFrEF were tested. Median (inter-quartile range) NT-proBNP concentrations among patients with HFrEF were 1399 (423-4087) pg/mL in Cohort 1 and 394 (142-688) pg/mL in Cohort 2. Median (inter-quartile range) NT-proBNP concentrations in the subset of patients with a WHFE in each cohort were 2209 (740-5894) and 464 (174-783) pg/mL, respectively. In Cohort 1, 13.4% of all HFrEF patients receiving NT-proBNP testing and 18.9% of patients with a WHFE had NT-proBNP values >8000 pg/mL; in Cohort 2, these percentages were 1.0% and 2.5%, respectively.
In US clinical practice, NT-proBNP testing was not frequently performed in patients with HFrEF. NT-proBNP concentrations varied across data sources and subpopulations within HFrEF.
N 端脑利钠肽前体（NT-proBNP）是心力衰竭中常用的生物标志物，用于诊断和预后判断。本研究旨在确定射血分数降低的心力衰竭（HFrEF）患者中 NT-proBNP 检测的流行率、NT-proBNP 浓度分布以及接受 NT-proBNP 检测的相关因素，包括心力衰竭恶化事件（WHFE）亚组。
这是一项使用美国两个数据库的回顾性队列研究：（i）2015 年 1 月至 2018 年 12 月期间的匿名 Humana Research Database，（ii）2013 年 7 月至 2017 年 9 月期间的 Veradigm PINNACLE 登记处。我们纳入了确诊为 HFrEF 的成年患者。在每个数据源中，确定了 WHFE 的亚组患者，其中 WHFE 定义为心力衰竭相关住院或静脉利尿剂治疗。进行了双变量和多变量分析，以评估与接受 NT-proBNP 检测相关的因素。在队列 1（n=249238）中，9.2%的 HFrEF 患者和 10.8%的 WHFE 患者接受了 NT-proBNP 检测。当限制在至少有一次实验室检测的患者中，11.3%的 HFrEF 患者和 13.2%的 WHFE 患者接受了 NT-proBNP 检测。在队列 2（n=91444）中，有 2.3%的 HFrEF 患者接受了检测。队列 1 中 HFrEF 患者的中位（四分位距）NT-proBNP 浓度为 1399（423-4087）pg/ml，队列 2 中为 394（142-688）pg/ml。每个队列中 WHFE 亚组患者的中位（四分位距）NT-proBNP 浓度分别为 2209（740-5894）和 464（174-783）pg/ml。在队列 1 中，接受 NT-proBNP 检测的所有 HFrEF 患者中有 13.4%和 WHFE 患者中有 18.9%的 NT-proBNP 值>8000pg/ml；在队列 2 中，这些百分比分别为 1.0%和 2.5%。
在美国临床实践中，HFrEF 患者并未频繁进行 NT-proBNP 检测。NT-proBNP 浓度在不同数据源和 HFrEF 亚组之间存在差异。
