Heart failure & cardiomyopathies
Racial differences in low natriuretic peptide levels: Implications for heart failure clinical trials
Authors' conclusion
Nearly 10% of patients hospitalized with HF have unexpectedly low BNP levels. Simulating inclusion into a prototype HFpEF RCT demonstrated that requiring increasingly elevated NP levels disproportionately excludes Black patients.
Study context
- Population
- Patients hospitalized with heart failure (HF) with BNP measurements, 2010–202052% Black
- Participants
- 31,704 patients
- Exposure
- Black vs non-Black patients
- Outcome
- Unexpectedly low BNP levels (<50 pg/mL) and associated factors
Methodological detailssimulation of trial eligibility
- Simulation of trial eligibility
Main finding
As reported in the abstract
Unexpectedly low BNP (<50 pg/mL)
Adjusted odds ratio (95% CI)
HFpEF
3.76(3.36–4.20)
Obesity
1.96(1.73–2.21)
Blackvs Non-Black
1.53(1.36–1.71)
Male gender
1.45(1.31–1.60)
- Prevalence of unexpectedly low BNP in cohort
- 8.9%
Observational data: associations, not effects.
Further findings
| Outcome | RR (95% CI) | |
|---|---|---|
| Risk of exclusion from simulated trial, by BNP thresholdBlackvs Non-BlackBNP ≥35 pg/mL | 2.03 (1.73–2.39) | |
| Risk of exclusion from simulated trial, by BNP thresholdBlackvs Non-BlackBNP ≥50 pg/mL | 1.90 (1.68–2.15) | |
| Risk of exclusion from simulated trial, by BNP thresholdBlackvs Non-BlackBNP ≥67 pg/mL | 1.63 (1.48–1.81) | |
| Risk of exclusion from simulated trial, by BNP thresholdBlackvs Non-BlackBNP ≥100 pg/mL | 1.38 (1.28–1.50) | |
| Risk of exclusion from simulated trial, by BNP thresholdBlackvs Non-BlackBNP ≥150 pg/mL | 1.23 (1.15–1.31) | |
| 0.512Relative risk (log scale) |
Exclusion by PARAGLIDE-HF clinical criteria
- Disproportionately excluded Black patients; impaired renal function had greatest impact
Original publication
Racial differences in low natriuretic peptide levels: Implications for heart failure clinical trials. Am Heart J. Published 19 June 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →