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 fractionLiterature - 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 . 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 .
Prevalence of NT-proBNP testing
- In Cohort 1 (N=249,238), 9.2% of all patients with HFrEF had an NT-proBNP test, whereas 10.8% of the HFrEF patients with a WHFE received this test. When restricted to patients with ≥1 laboratory claim, 11.3% and 13.2%, respectively, was subjected to testing.
- In Cohort 2 (N=91,444), the rate of NT-proBNP testing was 2.3%, both for all HFrEF patients and those with a WHFE.
Distribution and pattern of NT-proBNP concentration
- The median NT-proBNP concentration in HFrEF patients was 1399 pg/mL (IQR: 423–4087) in Cohort 1 (n=22,830) and 394 pg/mL (IQR: 142–688) in Cohort 2 (n=2108).
- In the subset of HFrEF patients with a WHFE, the median NT-proBNP concentration was 2209 pg/mL (IQR: 740–5894) in Cohort 1 and 464 pg/mL (IQR: 174–783) in Cohort 2.
- In Cohort 1, 13.4% of all HFrEF patients and 18.9% of those with a WHFE had a very high NT-proBNP level (>8000 pg/mL), whereas in Cohort 2, these percentages were 1.0% and 2.5%, respectively.
- Among the HFrEF patients with >1 NT-proBNP test, 57.7% in Cohort 1 (n=11,893) and 92.3% in Cohort 2 (n=932) had an initial NT-proBNP <4000 pg/mL, which was maintained below this cut-off value in subsequent tests.
Patient characteristics associated with receiving NT-proBNP testing
- Both female sex and having Medicare insurance (compared with commercial insurance) significantly increased the odds of receiving NT-proBNP testing.
- The majority of comorbidities investigated, such as pulmonary hypertension, T2DM, and COPD, also significantly increased these odds.
- However, certain other comorbidities, such as cancer and MI, significantly decreased the odds.
- Having more pharmacological HFrEF treatments was significantly associated with a lower likelihood of 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.