Racial Differences in Low Natriuretic Peptide Levels: Implications for Heart Failure Clinical Trials 公开

Abstract

Background: Some patients with heart failure (HF) have low natriuretic peptide (NP) levels. It is unclear whether these populations are disproportionately excluded from participation in randomized clinical trials (RCT) with inclusion requirements for elevated NPs. We investigated factors associated with unexpectedly low NP levels in a cohort of patients hospitalized with HF, and the implications on racial diversity in a prototype HF RCT.

Methods: We created a retrospective cohort of 31,704 patients (age 72 ± 16 years, 49% female, 52% Black) hospitalized with HF from 2010-2020 with B-type natriuretic peptide (BNP) measurements. Factors associated with unexpectedly low BNP levels (<50 pg/ml) were identified using multivariable logistic regression models. We simulated patient eligibility for a prototype HF trial using specific inclusion and exclusion criteria, and varying BNP cut-offs.

Results: Unexpectedly low BNP levels were observed in 8.9% of the cohort. Factors associated with unexpectedly low BNP levels included HFpEF (aOR 3.76, 95% CI 3.36-4.20), obesity (aOR 1.96, 95% CI 1.73 – 2.21), self-identification as Black (aOR 1.53, 95% CI 1.36 – 1.71), and male gender (aOR 1.45, 95% CI 1.31-1.60). Applying limited inclusion and exclusion criteria from PARAGLIDE-HF and adding BNP criteria ≥ 35, ≥ 50, ≥ 67, ≥ 100 and ≥ 150 pg/ml decreased the proportion of Black patients (44.6.0%, 43.7%*, 43.4%*, 43.3%*, and 43.3%*, respectively) eligible for RCT participation (* p<0.01).

Conclusions: Nearly 10% of patients hospitalized with HF have unexpectedly low BNP levels. Simulating inclusion into a prototype HF RCT demonstrated that requiring increasingly elevated NP levels disproportionately excluded Black patients.

Table of Contents

NA

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, General
关键词	Cardiology
Committee Chair / Thesis Advisor	Dr. Alanna Morris, Emory University Dr. Jordan Kempker, Emory University Dr. Neal Dickert, Emory University

最新修改

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	Racial Differences in Low Natriuretic Peptide Levels: Implications for Heart Failure Clinical Trials ()	2023-05-04 08:34:29 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions