Elsevier

American Heart Journal

Volume 166, Issue 6, December 2013, Pages 1063-1071.e3
American Heart Journal

Clinical Investigation
Heart Failure
Relationship between sex, ejection fraction, and B-type natriuretic peptide levels in patients hospitalized with heart failure and associations with inhospital outcomes: Findings from the Get With The Guideline–Heart Failure Registry

https://doi.org/10.1016/j.ahj.2013.08.029Get rights and content

Background

In heart failure (HF), there are known differences in plasma B-type natriuretic peptide (BNP) levels between reduced and preserved ejection fraction (EF), but few HF studies have explored sex differences. We sought to evaluate the relationship between sex, EF, and BNP in HF patients and determine prognostic significance of BNP as it relates to sex and EF.

Methods

We included hospitals in Get With The Guidelines–Heart Failure that admitted 99,930 HF patients with reduced (EF <40%), borderline (EF 40%-49%), or preserved (EF ≥50%) EF. The primary end point was inhospital mortality. Multivariate models were used to compute odds ratios while accounting for hospital clustering.

Results

There were 47,025 patients with reduced (37% female), 13,950 with borderline (48% female), and 38,955 with preserved (65% female) EF. Women compared with men had higher admission median BNP levels with the greatest difference among reduced EF and smallest difference among preserved EF (median BNP in women vs men: EF reduced 1,259 vs 1,113 pg/mL, borderline 821 vs 732 pg/mL, and preserved 559 vs 540 pg/mL; P < .001 all comparisons). Ejection fraction and sex were independently associated with BNP. Inhospital mortality was 2.7%, and patients above the median BNP level had higher mortality than those below. After adjusting for over 20 clinical variables, the ability of BNP to predict inhospital mortality was similar among all subgroups (P for heterogeneity = .47).

Conclusions

In a large registry, we found that despite sex/EF differences in BNP values, there was no significant difference in the ability of BNP to predict inhospital mortality among these subgroups.

Section snippets

Data source

We used the American Heart Association GWTG-HF registry, which has been previously described.12., 13., 14. Hospitals participating in the registry collect data for patients admitted with HF as the primary diagnosis to receive recommendations for qualitative improvement in medical management. These hospitals included large tertiary medical centers as well as small community hospitals across the United States. Data collected for each HF patient included demographics, medical/surgical history,

Results

The study cohort of 99,930 HF patients consisted of 47,025 patients admitted with HF and reduced EF (37% female, 63% male), 13,950 HF patients with borderline EF (48% female, 52% male), and 38,955 HF patients admitted with preserved EF (65% female, 35% male) from 277 fully participating hospital GWTG-HF hospitals. The median BNP was 816 pg/mL for the cohort with an IQR of 380 to 1,670 pg/mL. Table I shows the baseline characteristics of the cohort according to sex and EF. Median BNP levels on

Discussion

In a large, multicenter, national HF registry, we found women to have higher median BNP levels than men upon hospital admission for acute decompensated HF with reduced, borderline, and preserved EF. The median BNP levels were highest among HF patients with reduced EF and lowest among those with preserved EF. Admission BNP levels were independently associated with sex and EF. Inhospital mortality was 2.7% and similar among patients with reduced, borderline, and preserved EF. When patients were

Conclusions

In a large, multicenter registry, we found women to have higher median BNP levels than men upon hospital admission for HF with reduced, borderline, and preserved EF. Despite sex/EF differences in baseline BNP values, there were no significant differences in the ability of BNP to predict inhospital mortality among these subgroups. These findings expand the knowledge base regarding sex-based similarities and differences among hospitalized HF patients.

Disclosures

Funding and relationship with industry: The Get With The Guidelines–Heart Failure program is provided by the American Heart Association. The Get With The Guidelines–Heart Failure program has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. Adrian Hernandez receives funding from Johnson & Johnson, and Amylin and has received honorarium from Amgen and Corthera. Dr Deepak L. Bhatt discloses the

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Jerome L. Fleg, MD, served as guest editor for this article.

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