Physicians' Academy for Cardiovascular Education

How often is NT-proBNP measured in HFrEF patients in the USA ?

N-terminal pro-B-type natriuretic peptide testing patterns in patients with heart failure with reduced ejection fraction

Literature - Januzzi JL, Tan X, Yang L, et al. - ESC Heart Fail. 2022 Feb;9(1):87-99. doi: 10.1002/ehf2.13749

Introduction and methods


As NT-proBNP is an important biomarker for the diagnosis and prognosis of HF [1-3], clinical guidelines recommend that the NT-proBNP concentration is regularly measured and periodically updated [3]. However, patterns and results of NT-proBNP testing have not been well characterized in HFrEF patients, especially not following a worsening HF event (WHFE).

Aim of the study

The authors aimed to examine the prevalence of NT-proBNP testing, the distribution of the NT-proBNP concentration, and any patient characteristics associated with receiving NT-proBNP testing in HFrEF patients, including a subset with a WHFE.


In this retrospective cohort study, 2 databases from the USA were used: (a) de-identified Humana Research Database, which includes claims data of Humana’s insured individuals (data accessed were from January 2015 through December 2018) (Cohort 1); and (b) Veradigm PINNACLE Registry®, which is an outpatient registry that contains physician office medical claims, hospital claims, and pharmacy claims data of HF patients only (from July 2013 through September 2017) (Cohort 2). In each database, all adult patients with a confirmed diagnosis of HFrEF were identified, as well as a WHFE subgroup. WHFE was defined as a HF hospitalization or receipt of intravenous diuretics after the index diagnosis date .

Main results

Prevalence of NT-proBNP testing

Distribution and pattern of NT-proBNP concentration

Patient characteristics associated with receiving NT-proBNP testing


This study showed that HFrEF patients in American clinical practice did not receive regular NT-proBNP testing. In addition, the NT-proBNP concentration varied across healthcare settings and HFrEF subpopulations. The authors speculate that this low utilization of NT-proBNP testing could be due to the relatively large number of American patients without insurance or with poor insurance coverage, for whom the testing may be a significant financial burden.


Show references

Find this article online at ESC Heart Fail.

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